Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

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Je Hwan Yoon

2013-01-01

Full Text Available Aims: To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery. Materials and Methods: This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes. The outcome measures were surgically induced astigmatism (SIA and uncorrected visual acuity (UCVA 1 and 3 months, post-operatively. Results: At 1 month, the mean SIA was 0.81 diopter (D for the temporal incisions and 0.92 D for nasal incisions (P = 0.139. At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309. The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively. Conclusion: After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less would be favorable for astigmatism-neutral cataract surgery.

Comparison of corneal endothelial changes following phacoemulsification with transversal and torsional phacoemulsification machines.

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Ataş, Mustafa; Demircan, Süleyman; Karatepe Haşhaş, Arzu Seyhan; Gülhan, Ahmet; Zararsız, Gökmen

2014-01-01

To compare and evaluate the phacoemulsification parameters and postoperative endothelial cell changes of two different phacoemulsification machines, each with different modes, but also to assess the relationship between postoperative endothelial cell loss and the phacoemulsification parameters, as well as the other factors in both groups. This prospective observational study was comprised of consecutive eligible cataract patients operated with phacoemulsification technique performed by the same surgeon using either a WHITESTAR Signature Ellips FX (transversal, group 1) or Infiniti OZil IP (torsional, group 2) machine. The study included 86 patients. Baseline characteristics in the groups were similar. The median nuclear sclerosis grade was 3 (2-4) in the first group and 2 (2-4) in the second group (P=0.265). Both groups had similar phacoemulsification needle times (group 1: 60.63±36 s; group 2: 55.98±30 s; P=0.789). The percentage of endothelial cell loss 30d after surgery ranged from 3% to 15% with a median of 7% in group 1, and from 2% to 13% with a median of 6% in group 2; however, there was no statistically significant difference between the groups (P=0.407). Hexagonality (P=0.794) and the coefficient of variation (CV; P=0.142) did not differ significantly between the groups before and 30d after surgery. A significant positive correlation was found between the endothelial cell loss and nuclear sclerosis grade (group 1: P<0.001; group 2: P<0.001) and between the endothelial cell loss and average phacoemulsification power (group 1: P=0.007; group 2: P=0.008). Both of these machines were efficient, with similar endothelial cell loss. This endothelial cell loss was related to the increased nuclear sclerosis grade and increased phacoemulsification power.

[Slit lamp optical coherence tomography study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation].

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Yan, Pi-song; Zhang, Zhen-ping; Lin, Hao-tian; Wu, Wen-jie; Bai, Ling

2009-09-01

To investigate quantitative changes of the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation with slit-lamp-adapted optical coherence tomography (SL-OCT). In prospective consecutive case series, clear corneal incision phacoemulsification and foldable intraocular lens implantation were performed in 44 eyes of 40 patients. The changes of the anterior segment configuration were performed by SL-OCT before and 1 day, 1 week, 2 weeks and 1 month after surgery. SPSS 16.0 software was used to analyze statistical difference. For all patients, the central corneal thickness (CCT) and the incisional corneal thickness (ICT) increased significantly 1 day after surgery (CCT increased 99.59 microm, ICT increased 234.57 microm; P = 0.490). At 1 month, the CCT almost had returned to baseline, but the ICT had been thicker about 19.25 microm than baseline(P = 0.001). The measurements of ACD, AOD500, AOD750, TISA500, TISA750 also increased significantly 1 day after surgery. Although the ACD had no changes within 2 weeks (all P 0.05). The SL-OCT could impersonality and quantificationally evaluate the anterior segment changes induced by cataract surgery.

Effects of phacoemulsification combined with intraocular lens implantation on ocular surface

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Ming Li

2013-10-01

Full Text Available AIM: To explore the changes of ocular surface after phacoemulsification combined with intraocular lens implantation. METHODS: Totally 78 cases of 78 eyes with age-related cataract were collected from August 2011 to October 2012, and they underwent corneal incision phacoemulsification combined with intraocular lens implantation. The score of dry eye symptoms; tear breakup time(BUT; Schirmer Ⅰ test(SⅠtand corneal fluorescein staining were observed and recorded in 3 days before, 1 day, 1 week, 1 month, 3 and 6 months after surgery respectively. The results were analyzed statistically. RESULTS: All the subjects complained of dry eye within 1 week after surgery. Compared with 3 days before the surgery, the corneal fluorescein staining increased and the amount of tear secretion reduced statistically significant in 1 day, 1 week and 1 month(PPP>0.05, and lasted to 3 months later. CONCLUSION: Phacoemulsification combined with intraocular lens implantation has obvious effect on the ocular surface to some extent. Preventions and treatment should be taken clinically.

[Effectivity and Safety of a Modified Tip Design in Torsional Phacoemulsification].

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Schmidt, Sabine; Hubich, Sophie; Vetter, Jan Markus; Wirbelauer, Christopher

2018-02-16

Torsional mode phacoemulsification results in more effective fragmentation of the nucleus due to a different movement of the phacotip. In this clinical study, we investigated the influence of a modified tip design and active fluidics on the efficacy of phacoemulsification and safety for the corneal endothelium. We conducted a prospective randomized 2 : 1 study in which 40 patients were operated on with the mini-flared Kelman Tip using the Infiniti ® System (group 1), and 20 patients were operated on with the Intrepid ® Balanced Tip and the Centurion ® System. We analyzed the intraoperative cumulative dissipated energy and also the density of the corneal endothelium measured with an endothelial microscope (CEM 530, Nidek) pre- and postoperatively. Both groups did not differ preoperatively in age, sex, axial length of the globe or corneal endothelium cell density nor cataract density (LOCS3). All surgeries were uneventful. The cumulative dissipated energy in group 1 (mini-flared Kelman tip, Infiniti System) was 38% higher than in group 2 (balanced tip, Centurion System; p  0.05). The cell size (polymegathism) increased in both groups significantly with + 37 µm in group 1 (p  0.05). The number of hexagonal cells (pleomorphism) and corneal thickness did not differ in both groups either pre- nor postoperatively. Compared to torsional phacoemulsification with a mini-flared Kelman Tip and gravity fluidics, torsional phacoemulsification with a modified tip design and active fluidics is 38% more effective regarding the cumulative dissipated energy. Endothelial cell loss occurs to a similar extend using both systems. The postoperative changes in cell size (polymegathism), number of hexagonal cells (pleomorphism) and corneal thickness (pachymetry) were similar among both systems. We conclude, that the intraoperative stress on the endothelium is equivalent with both systems used. Georg Thieme Verlag KG Stuttgart · New York.

Incision integrity and postoperative outcomes after microcoaxial phacoemulsification performed using 2 incision-dependent systems.

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Vasavada, Vaishali; Vasavada, Abhay R; Vasavada, Viraj A; Srivastava, Samaresh; Gajjar, Devarshi U; Mehta, Siddharth

2013-04-01

To compare incision integrity and clinical outcomes of 2 microcoaxial phacoemulsification systems. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Prospective randomized clinical trial. Eyes were randomized to have phacoemulsification using a 1.8 mm clear corneal incision (CCI) system (Group 1, Stellaris system) or a 2.2 mm CCI system (Group 2, Intrepid Infiniti system). Incision enlargement at end of surgery was measured. At the conclusion of surgery, trypan blue was applied over the conjunctival surface, anterior chamber aspirate withdrawn, and ingress into anterior chamber measured. Postoperative observations included evaluation of the CCI using anterior segment optical coherence tomography (AS-OCT), change in central corneal thickness (CCT), and anterior segment inflammation at 1 day, 1 week, and 1 month and endothelial cell loss and surgically induced astigmatism (SIA) at 3 months. Incision enlargement (P.05). At the end of surgery, it is not the initial incision size alone but also the distortion of the incision during subsequent stages of surgery that determine the integrity of the CCI. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Corneal endothelial cell changes associated with cataract surgery in patients with type 2 diabetes mellitus

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Hugod, Mikkel; Storr-Paulsen, Allan; Norregaard, Jens Christian

2011-01-01

To investigate the corneal endothelial cell density and morphology in patients with and without diabetes after phacoemulsification with intraocular lens implantation.......To investigate the corneal endothelial cell density and morphology in patients with and without diabetes after phacoemulsification with intraocular lens implantation....

The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts.

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Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak; Kim, Mee-Kum

2010-12-01

To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.

The Comparison between Torsional and Conventional Mode Phacoemulsification in Moderate and Hard Cataracts

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Kim, Dong-Hyun; Wee, Won-Ryang; Lee, Jin-Hak

2010-01-01

Purpose To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. Methods Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. Results Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. Conclusions Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage. PMID:21165231

Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study.

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Vasavada, Viraj; Vasavada, Vaishali; Raj, Shetal M; Vasavada, Abhay R

2007-06-01

To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. A prospective observational case series comprised 84 eyes with age-related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single-piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1-sample t test with 95% confidence intervals (CIs). The mean follow up was 3 months +/- 0.3 (SD). The mean incision size at the end of surgery was 2.3 +/- .09 mm; mean surgical time, 4.5 +/- 1.5 minutes; and mean CDE, 2.3 +/- 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 microm at 1 day (95% CI, 8-25; P = .66;) and by a mean of 3.14 microm at 1 month (95% CI, 2.26-4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8-3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5-2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

Influence factors of visual quality after phacoemulsification for cataract

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Zhen-Lin Lin

2017-12-01

Full Text Available Cataract refers to the degenerative changes in lens quality caused by various causes of reduced transparency or color change. Surgical treatment is the main treatment modality at present. Among them, phacoemulsification has become the main surgical treatment for cataract because of its advantages such as short operation time, small incision and quicker healing. Today, cataract surgery has gradually shift to refractive surgery, and is no longer simply as cataract surgery. But after cataract phacoemulsification, the symptoms and visual quality are different. The main causes include refractive error, postoperative dry eyes and postoperative corneal astigmatism. This article reviews the factors that influence the visual quality of cataract phacoemulsification and its future trends.

Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification.

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Titiyal, Jeewan S; Khatik, Mukesh; Sharma, Namrata; Sehra, Sri Vatsa; Maharana, Parfulla K; Ghatak, Urmimala; Agarwal, Tushar; Khokhar, Sudarshan; Chawla, Bhavana

2014-05-01

To compare toric intraocular lens (IOL) implantation and astigmatic keratotomy (AK) in correction of astigmatism during phacoemulsification. Tertiary care hospital. Prospective randomized trial. Consecutive patients with visually significant cataract and moderate astigmatism (1.25 to 3.00 diopters [D]) were randomized into 2 groups. Temporal clear corneal 2.75 mm phacoemulsification with toric IOL implantation was performed in the toric IOL group and with 30-degree coupled AK at the 7.0 mm optic zone in the keratotomy group. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, keratometry, topography, central corneal thickness, and endothelial cell density were evaluated preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. The study enrolled 34 eyes (34 patients), 17 in each group. There was no difference in UDVA or CDVA between the 2 groups at any follow-up visit. The mean preoperative and postoperative refractive cylinder was 2.00 D ± 0.49 (SD) and 0.33 ± 0.17 D, respectively, in the toric IOL group and 1.95 ± 0.47 D and 0.57 ± 0.41 D, respectively, in the keratotomy group (P=.10). The mean residual astigmatism at 3 months was 0.44 ± 1.89 @ 160 in the toric IOL group and 0.77 ± 1.92 @ 174 in the keratotomy group (P=.61). All eyes in the toric IOL group and 14 eyes (84%) in the keratotomy group achieved a residual refractive cylinder of 1.00 D or less (P=.17). Toric IOL implantation was comparable to AK in eyes with moderate astigmatism having phacoemulsification. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Fluid temperature at the corneal endothelium during phacoemulsification: comparison of an ophthalmic viscosurgical device and balanced salt solution using the finite element method.

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Reepolmaha, Somporn; Limtrakarn, Wiroj; Uthaisang-Tanechpongtamb, Wanlaya; Dechaumphai, Pramote

2010-01-01

The purpose of this study was to estimate and compare the temperatures of two different anterior chamber solutions at the corneal endothelial level during phacoemulsification. An ophthalmic viscosurgical device (OVD) and balanced salt solution (BSS) were compared using the finite element method (FEM). The thermal properties of an OVD (IAL-F) and BSS were studied in an experimental setting. A computer-aided design model of ocular anatomy was created in two dimensions. The phaco needle was considered to be the only source of heat generation. Then, the FEM was used to demonstrate the transient temperature distribution in the two ocular models at 10, 20, 30, 40, 50 and 60 s. In these models, the anterior chamber was filled with IAL-F (IAL-F model) or BSS (BSS model). The heat generation rate of the phaco needle was 0.0004 cal/s/mm(2). The maximum corneal endothelial temperatures for the two models at 60 s were 52.67 and 41.57 degrees C, respectively. The experimental IAL-F model showed fewer changes in temperature for any given time and location. At larger distances from the heat source, less temperature variation was detected. Phacoemulsification is a potential heat-generating procedure performed between the delicate anterior chamber structures. During this procedure, IAL-F protects the endothelium against heat better than BSS. Copyright 2009 S. Karger AG, Basel.

Treatment of a dislocated lens by transcorneal vitrectomy and bimanual phacoemulsification

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Watanabe A

2014-08-01

Full Text Available Akira Watanabe, Tamaki Gekka, Hiroshi Tsuneoka Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan Background: As a method of treatment for a dropped lens nucleus, which occurred during cataract surgery, the dropped lens nucleus was removed through the corneal wound without using pars plana vitrectomy (PPV. After vitrectomy, the dropped lens nucleus was floated on the perfluorocarbon liquid (PFCL. The floating lens nucleus was then phacoemulsified and aspirated. During surgery, irrigation from the anterior chamber was performed. This method was very effective for treatment of a dropped hard nucleus.Case report: During cataract surgery on the left eye of an 80-year-old woman, a posterior capsule rupture occurred. As a result, the lens nucleus dropped into the vitreous cavity. Irrigation to the anterior chamber was performed, with an anterior chamber maintainer inserted through a newly created side port at the corneal limbus. A vitreous cutter and a light guide were inserted in order to perform vitrectomy through the corneal incisions that were created for the cataract surgery. After vitrectomy, the dropped lens nucleus was floated using PFCL. The floating lens nucleus was removed by a bimanual phacoemulsification technique, with the anterior chamber irrigation continuing. The separation of the irrigation port and the aspiration port allowed for effective treatment of the dropped nucleus that was floating on the PFCL, even using a ­phacoemulsification machine with a peristaltic pump system. Safe and effective vitrectomy, similar to a PPV, could be performed with this method using three corneal ports.Conclusion: This technique may allow safer and more effective treatment for a dropped lens nucleus compared with conventional PPV. With this technique, corneal distortion due to surgical manipulation can lead to reduced visibility of the posterior eye. Keywords: dislocated lens, transcorneal vitrectomy, bimanual

The correlation between variation of visual acuity and the anterior chamber depth in the early period after phacoemulsification

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Kai-jian CHEN

2011-04-01

Full Text Available Objective To investigate the correlation between the visual acuity variation and the anterior chamber depth in the early period after phacoemulsification.Methods Thirty-six eyes of 32 patients with age-related cataract underwent 3.2mm clear corneal incision phacoemulsification and intraocular lens(IOL implantation.The visual acuity was examined and horizontal curvature(K1,vertical curvature(K2,corneal astigmatism,and anterior chamber depth were measured with IOL-master preoperatively and also on 1,3,7 and 15 postoperative days.The changes in parameters were compared,and the correlations among visual acuity,corneal astigmatism and anterior chamber depth were analyzed.Results Before operation and 1d,3d,7d and 15d after operation,the corneal astigmatism was-0.87±0.40D,-1.92±1.38D,-1.69±1.13D,-1.45±0.79D and-1.36±0.74D;the anterior chamber depth was 3.08±0.35mm,4.04±0.38mm,4.28±0.29mm,4.22±0.17mm and 4.22±0.16mm;the visual acuity was 0.18±0.10,0.44±0.14,0.59±0.12,0.61±0.11 and 0.62±0.14.Significant difference was found between pre-operative and postoperative visual acuity,corneal astigmatism and anterior chamber depth,and it was also found in corneal astigmatism between 1d and 15d post operation(P < 0.05,as well as in anterior chamber depth and visual acuity between 1d and 3d post operation(P < 0.05.A positive correlation was found between visual acuity and corneal astigmatism on 1d(r=0.42,P < 0.05,3d(r=0.35,P < 0.05 and 7d(r=0.35,P < 0.05 post operation;and a negative correlation was found between visual acuity and anterior chamber depth on 3d(r=-0.29,P < 0.05,7d(r=-0.43,P < 0.01 and 15d(r=-0.37,P < 0.05 post operation.Conclusion Both the corneal astigmatism and the anterior chamber depth are correlated with the visual acuity variation in the early period after phacoemulsification.

Epithelial ingrowth under a laser in situ keratomileusis flap after phacoemulsification.

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Braunstein, Richard E; Airiani, Suzanna; Chang, Stanley

2003-11-01

A 47-year-old man was referred to us for management of a cataract in the left eye. The patient had an ocular history of high myopia with anisometropia, amblyopia in the left eye, and stable myopic lattice degeneration in both eyes. The patient had successful bilateral laser in situ keratomileusis 3 years before and multiple retinal surgeries for treatment of a rhegmatogenous retinal detachment associated with a giant retinal tear in the temporal region of the retina with subsequent proliferative vitreoretinopathy. Phacoemulsification was performed uneventfully. A single interrupted 10-0 nylon suture was placed in the temporal clear corneal wound and removed 7 weeks postoperatively. One month later, slitlamp examination revealed a 1.5 mm tongue-like area of epithelial ingrowth under the corneal flap. The epithelial cells seemed to enter the flap-stroma interface through the previously placed suture tract and advanced centrally.

Comparison of torsional and microburst longitudinal phacoemulsification: a prospective, randomized, masked clinical trial.

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Vasavada, Abhay R; Raj, Shetal M; Patel, Udayan; Vasavada, Vaishali; Vasavada, Viraj

2010-01-01

To compare intraoperative performance and postoperative outcome of three phacoemulsification technologies in patients undergoing microcoaxial phacoemulsification through 2.2-mm corneal incisions. The prospective, randomized, single-masked study included 360 eyes randomly assigned to torsional (Infiniti Vision System; Alcon Laboratories, Fort Worth, TX), microburst with longitudinal (Infiniti), or microburst with longitudinal (Legacy Everest, Alcon Laboratories) ultrasound. Assessments included surgical clock time, fluid volume, and intraoperative complications, central corneal thickness on day 1 and months 1 and 3 postoperatively, and endothelial cell density at 3 months postoperatively. Comparisons among groups were conducted. Torsional ultrasound required significantly less surgical clock time and fluid volume than the other groups. There were no intraoperative complications. Change in central corneal thickness and endothelial cell loss was significantly lower in the torsional ultrasound group at all postoperative visits (P < .001, Kruskal-Wallis test) compared to microburst longitudinal ultrasound modalities. Torsional ultrasound demonstrated quantitatively superior intraoperative performance and showed less increase in corneal thickness and less endothelial cell loss compared to microburst longitudinal ultrasound. Copyright 2010, SLACK Incorporated.

Complex descemet′s membrane tears and detachment during phacoemulsification

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Faik Orucoglu

2015-01-01

Full Text Available Purpose: To report a case of complex Descemet′s membrane detachment (DMD and tears during phacoemulsification cataract surgery. Case Report: A 64-year-old woman underwent phacoemulsification surgery in her right eye and developed tears and partial loss of Descemet′s membrane (DM while the aspiration port was inserted through the main incision. Massive corneal edema obscured the view and the anterior chamber was barely visible the following day. Scheimpflug imaging was used to complement slit lamp examination in the postoperative period. Frequent topical corticosteroid drops were initiated. After 5 days of treatment, multiple tears and detachment of DM were visible and the anterior chamber was filled with air. After 5 weeks, the cornea regained much of its clarity despite large DM tears and focal loss of DM. Conclusion: Despite partial loss of DM, the corneal edema mostly disappeared after 5 weeks of air bubble injection. Scheimpflug imaging was beneficial in the diagnosis and monitoring of DM tears and detachments.

Clinical observation of phacoemulsification in patients with previous trabeculectomy

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Li Li

2013-09-01

Full Text Available AIM: To observe the clinical effect of transparent corneal incision phacoemulsification in cataract patients who had undergone different kinds of glaucoma filtration surgeries.METHODS: Totally 43 cases(50 eyes, in which 23 patients with primary angle-closure glaucoma(group A, 26 eyesand 20 patients with primary open angle glaucoma(group B, 24 eyes, all had undergone glaucoma filtration surgery for more than 6 months. Visual acuity, intraocular pressure, slit lamp, gonioscope, corneal endothelial cell counts, etc., were done before surgery.And transparent corneal incision phacoemulsification combined with artificial lens implantation operation were preformed, postoperative follow-up of 3 to 12 months, visual acuity, intraocular pressure, corneal endothelial cell counts and vision field, etc. were observed and recorded.RESULTS: The visual acuity of 50 eyes(100%increased with different degree postoperatively, 41 eyes(82%with postoperative visual acuity ≥0.3; average preoperative intraocular pressure: group A 18.08±5.08mmHg(1mmHg=0.133kpa, group B 14.48±3.52mmHg; Postoperative follow-up average intraocular pressure: group A 13.65±3.51mmHg, group B 14.28±3.41 mmHg, intraocular pressure changed significantly pre and post-operation in group A(PP>0.05; Postoperative intraocular pressure of 1 eye in group A and 3 eyes in group B rose within three days post-operation, the intraocular pressure fluctuated between 21-33mmHg, with drug therapy and drug withdral when intraocular pressure epistrophy; Intraocular pressure was stable in the follow-up process.Corneal endothelial cell density: pre-operation group A was 2 293.57±352.24(cells/mm2, group B 2 658.14±458.69(cells/mm2, post- operation group A 2 175.95±379.16(cells/mm2, group B 2 442.97±477.30(cells/mm2, cell loss rate: 5.13% in group A, and 8.10% in group B. Postoperative visual acuity was related to vision field damage in patients, the more visual field damage, the longer the duration

Intraoperative performance and postoperative outcome comparison of longitudinal, torsional, and transversal phacoemulsification machines.

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Christakis, Panos G; Braga-Mele, Rosa M

2012-02-01

To compare the intraoperative performance and postoperative outcomes of 3 phacoemulsification machines that use different modes. Kensington Eye Institute, Toronto, Ontario, Canada. Comparative case series. This chart and video review comprised consecutive eligible patients who had phacoemulsification by the same surgeon using a Whitestar Signature Ellips-FX (transversal), Infiniti-Ozil-IP (torsional), or Stellaris (longitudinal) machine. The review included 98 patients. Baseline characteristics in the groups were similar; the mean nuclear sclerosis grade was 2.0 ± 0.8. There were no significant intraoperative complications. The torsional machine averaged less phacoemulsification needle time (83 ± 33 seconds) than the transversal (99 ± 40 seconds; P=.21) or longitudinal (110 ± 45 seconds; P=.02) machines; the difference was accentuated in cases with high-grade nuclear sclerosis. The torsional machine had less chatter and better followability than the transversal or longitudinal machines (P<.001). The torsional and longitudinal machines had better anterior chamber stability than the transversal machine (P<.001). Postoperatively, the torsional machine yielded less central corneal edema than the transversal (P<.001) and longitudinal (P=.04) machines, corresponding to a smaller increase in mean corneal thickness (torsional 5%, transversal 10%, longitudinal 12%; P=.04). Also, the torsional machine had better 1-day postoperative visual acuities (P<.001). All 3 phacoemulsification machines were effective with no significant intraoperative complications. The torsional machine outperformed the transversal and longitudinal machines, with a lower mean needle time, less chatter, and improved followability. This corresponded to less corneal edema 1 day postoperatively and better visual acuity. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Bimanual microincision phacoemulsification in treating hard cataracts using different power modes.

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Liu, Yizhi; Jiang, Yuzhen; Wu, Mingxing; Liu, Yuhua; Zhang, Tieying

2008-07-01

To compare the performance of the Multiburst mode, the Shortpulse mode and the Whitestar technology of the Sovereign platform in treating hard cataracts with bimanual microincision phacoemulsification. 101 eyes with hard cataracts (nuclear density Grade 3 and Grade 4 or above) were randomized into three groups. Bimanual microincision phacoemulsification was performed using the Multiburst mode, the Shortpulse mode and the Whitestar technology of the Sovereign phacoemulsification machine respectively. The average power, total duration of ultrasonic power release (US Time), effective phaco time, complications, best-corrected visual acuity and rate of corneal endothelial cell loss were measured and compared among the study groups. For hard cataracts of various nuclear densities, average ultrasonic power was highest in the Whitestar group followed by the Shortpulse group. The Multiburst group had the highest US Time, effective phaco time and rate of corneal endothelial cell loss whereas the Whitestar Group had the lowest.The differences between the groups were found to be statistically significant by variation analysis and the Fisher's least significant difference procedure. However, there were no significant differences between the USTime values of the Shortpulse Group and the Whitestar Group (P = 0.051). In the Multiburst Group, wound burn occurred in one eye, and three eyes had abnormal fluctuations in the anterior chamber depth. The Whitestar technology showed the best performance in this study.The Multiburst mode was proved to be a relatively unsuitable ultrasonic power mode in treating hard cataracts with bimanual microincision phacoemulsification.

Application of Corvis ST to evaluate the effect of femtosecond laser-assisted cataract surgery on corneal biomechanics.

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Wei, Yinjuan; Xu, Lingxiao; Song, Hui

2017-08-01

The aim of the present study was to evaluate the effects of femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification on corneal biomechanics using corneal visualization Scheimpflug technology. The medical records of 50 eyes from 50 patients who received phacoemulsification and intraocular lens implantation because of age-related factors between June 2014 and September 2014 were retrospectively analyzed. FLACS was used in 12 eyes (FLACS group), and conventional phacoemulsification in 38 eyes (PHACO group). The evaluation of corneal biomechanical parameters included the first/second applanation time (A-time1/A-time2), the first/second applanation length (A-length1/A-length2), corneal velocity during the first/second applanation moment (Vin/Vout), highest concavity time, highest concavity-radius (HC-radius), peak distance (PD), deformation amplitude (DA), central corneal thickness (CCT), and intraocular pressure (IOP). The differences in A-length1/A-length2, IOP, CCT, PD, and DA were significant in the PHACO group between those before, 1 week after, and 1 month after surgery. No significant differences in corneal biomechanical parameters were found between those at 1 month after surgery and before surgery. There were significant differences in IOP and CCT in the FLACS group between those before, 1 week after, and 1 month after surgery. There were no significant differences in the other corneal biomechanical parameters. No significant differences were found in corneal biomechanical parameters between those 1 month after surgery and before surgery. There were significant differences in A-length1/A-length2, CCT, PD, and DA between the two groups at 1 week after surgery. There were no significant differences in corneal biomechanical parameters between the two groups at 1 month after surgery. In conclusion, the effect of FLACS on corneal biomechanics is smaller than that of phacoemulsification. The corneal biomechanical parameters are restored to

Surpresa refrativa pós-facoemulsificação em distrofia corneana posterior amorfa Post-phacoemulsification refractive surprise in a posterior amorphous corneal dystrophy patient

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Giuliano de Oliveira Freitas

2010-02-01

Full Text Available Relato de um caso de surpresa refracional pós-operatória não pretendida em paciente portador de distrofia corneana posterior amorfa submetida à facoemulsificação. A provável causa do erro, bem como a conduta tomada a partir do reconhecimento da mesma, são discutidas neste relato.One case of post-phacoemulsification refractive surprise in a posterior amorphous corneal dystrophy patient is reported herein. Its likely causative factor, as well as our approach once it was recognized are discussed in this report.

Irrigation port hydration in phacoemulsification surgery

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Suzuki H

2018-01-01

Full Text Available Hisaharu Suzuki,1 Yoichiro Masuda,2 Yuki Hamajima,1 Hiroshi Takahashi3 1Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, Kawasaki City, Kanagawa, 2Department of Ophthalmology, The Jikei University, Katsushika Medical Center, Tokyo, 3Department of Ophthalmology, Nippon Medical School, Tokyo, Japan Background: In most cases, hydration is performed by water injection into the stromal tissue with a needle. The technique is simple, however it is sometimes troublesome.Purpose: We describe a simple technique for hydrating the corneal stroma in cataract surgery using an irrigation port.Patients and methods: The technique began by pushing the irrigation port against the corneal stroma for a few seconds during phacoemulsification, which generated edema in the corneal incision that subsequently prevented leakage. This procedure is called the hydration using irrigation port (HYUIP technique. A total of 60 eyes were randomized and placed in two groups, 30 eyes underwent surgeries using the HYUIP technique (HYUIP group and 30 eyes underwent surgeries without the HYUIP technique (control. The three points evaluated during each surgery included 1 the occurrence of anterior chamber collapse during the pulling out of the I/A tip after inserting the intraocular lens, 2 the need for conventional hydration, and 3 watertight completion at the end stage of surgery.Results: The anterior chamber collapse and the need for conventional hydration were significantly smaller in the HYUIP group compared to the control group. Regarding the self-sealing completion, no significant difference was observed between the two groups.Conclusion: The HYUIP technique is an effective method for creating self-sealing wound. In addition, this technique helps to prevent anterior chamber collapse. Keywords: cataract surgery, hydration, irrigation and aspiration, phacoemulsification, wound, self-sealing 

Comparison of 21G curved and straight phacotips designs in transversal microcoaxial phacoemulsification

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Süleyman Demircan

2015-12-01

Full Text Available AIM:To compare the intraoperative performance and postoperative outcomes after microcoaxial torsional phacoemulsification using the straight and the curved phacotip configurations.METHODS:Cataracts were treated using 2.2mm microcoaxial transversal phacoemulsification with either a 30°straight or 30° curved phaco tip. Intraoperative measurements analyzed included the average ultrasound(U/Spower, the total phacoemulsification time, and the effective phacoemulsification time(EPT. The central endothelial cell density(ECDand the central corneal thickness(CCTwere evaluated preoperatively and postoperatively at 1, 7 and 30d after surgery using noncontact specular microscopy. RESULTS:The study enrolled a total of 190 eyes(190 patients, 95 eyes in the curved tip group and 95 eyes in straight tip group. Intraoperative measurements showed significantly reduced total phacoemulsification time, and EPT in the curved-tip group, compared to the straight-tip group(Pst-3rd quartilesand 18.0(9.0-30.0s in curved-tip group, and 38.8(16.5-73.5s and 26.0(11.0-49.0s in the straight-tip group, respectively. CONCLUSION:Transversal phacoemulsification performed with a curved tip provided more effective lens removal with a less total UST and EPT in all grades, except for grades IV, compared to a straight tip.

Corneal tissue welding with infrared laser irradiation after clear corneal incision.

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Rasier, Rfat; Ozeren, Mediha; Artunay, Ozgür; Bahçecioğlu, Halil; Seçkin, Ismail; Kalaycoğlu, Hamit; Kurt, Adnan; Sennaroğlu, Alphan; Gülsoy, Murat

2010-09-01

The aim of this study was to investigate the potential of infrared lasers for corneal welding to seal corneal cuts done in an experimental animal model. Full-thickness corneal cuts on freshly enucleated bovine eyes were irradiated with infrared (809-nm diode, 980-nm diode, 1070-nm YLF, and 1980-nm Tm:YAP) lasers to get immediate laser welding. An 809-nm laser was used with the topical application of indocyanine green to enhance the photothermal interaction at the weld site. In total, 60 bovine eyes were used in this study; 40 eyes were used in the first part of the study for the determination of optimal welding parameters (15 eyes were excluded because of macroscopic carbonization, opacification, or corneal shrinkage; 2 eyes were used for control), and 20 eyes were used for further investigation of more promising lasers (YLF and Tm:YAP). Laser wavelength, irradiating power, exposure time, and spot size were the dose parameters, and optimal dose for immediate closure with minimal thermal damage was estimated through histological examination of welded samples. In the first part of the study, results showed that none of the applications was satisfactory. Full-thickness success rates were 28% (2 of 7) for 809-nm and for 980-nm diode lasers and 67% (2 of 3) for 1070-nm YLF and (4 of 6) for 1980-nm Tm:YAP lasers. In the second part of the study, YLF and Tm:YAP lasers were investigated with bigger sample size. Results were not conclusive but promising again. Five corneal incisions were full-thickness welded out of 10 corneas with 1070-nm laser, and 4 corneal incisions were partially welded out of 10 corneas with 1980-nm laser in the second part of the study. Results showed that noteworthy corneal welding could be obtained with 1070-nm YLF laser and 1980-nm Tm:YAP laser wavelengths. Furthermore, in vitro and in vivo studies will shed light on the potential usage of corneal laser welding technique.

Femtosecond phacoemulsification: the business and the medicine.

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Uy, Harvey S; Edwards, Keith; Curtis, Nick

2012-01-01

PURPOSE FOR REVIEW: Phacoemulsification is the preferred method for cataract surgery in the developed world. The number of phacoemulsification procedures performed annually is expected to increase as the population ages. Femtosecond cataract surgery offers several surgical advantages over conventional phacoemulsification and has already attained commercial application in some countries. The purpose of this review is to outline the benefits, risks and commercial issues of femtosecond lasers as applied to cataract surgery. Cataract surgeons are adopting femtosecond technology to perform laser capsulotomy, lens fragmentation, clear cornea incisions and limbal relaxing incisions. Femtosecond lasers clearly perform these surgical steps with greater precision and reproducibility. Further benefits such as improved postoperative refractive results and reduced complication rates are being investigated. Commercial issues have invariably arisen such as cost of installation and operation, value proposition and return on investment. Femtosecond cataract surgery is an evolving procedure that can potentially lead to better and safer surgical outcomes. This review presents the currently available scientific evidence and discusses some of the relevant financial issues concerning this technology.

Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery.

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Mayer, Wolfgang J; Klaproth, Oliver K; Hengerer, Fritz H; Kohnen, Thomas

2014-02-01

To compare effective phacoemulsification time in cataract surgery performed by manual phacoemulsification vs femtosecond laser-assisted lens fragmentation. Retrospective, consecutive, nonrandomized, comparative case series. The setting was the Department of Ophthalmology, Goethe-University, Frankfurt, Germany. The study population included 150 eyes of 86 patients with senile cataract. In the intervention, 88 eyes (group 1) underwent femtosecond laser-assisted surgery (corneal incisions, capsulotomy, lens fragmentation) using the LenSx platform (Alcon) and residual lens work-up with pulsed ultrasound energy (Infiniti Vision System; Alcon). In 62 eyes (group 2), complete cataract removal was performed with phacoemulsification only, using pulsed ultrasound energy with the same device (Infiniti). Nucleus staging (Pentacam nucleus staging; PNS) was evaluated using Pentacam HR (Oculus); endothelial cell density was measured using specular microscopy (NonCon Robo). The main outcome measures were as follows. Mean preoperative PNS staging was assessed using an automatic ordinal scaling (PNS-O, grades 0-5) and a manually defined density grid derived from Scheimpflug imaging (PNS-P [%]). Effective phacoemulsification time and endothelial cell loss were evaluated in both groups. Preoperative PNS-O and PNS-P showed no significant difference between groups (P = 0.267). Overall mean effective phacoemulsification time was significantly lower in group 1 (1.58 ± 1.02 seconds) compared to 4.17 ± 2.06 seconds in group 2 (P = 0.001). Effective phacoemulsification time was significantly lower in group 1 for all PNS-O stages (P < 0.001). With increasing preoperative PNS-P, effective phacoemulsification time increased in both groups; however, this gain was noticeably, but not significantly, lower in group 2. Endothelial cell loss was significantly lower in group 1 (P = 0.02). Femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time

Optical coherence tomography of the effects of stromal hydration on clear corneal incision architecture.

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Calladine, Daniel; Tanner, Vaughan

2009-08-01

To evaluate the effects of stromal hydration on clear corneal incision (CCI) architecture immediately after surgery using anterior segment optical coherence tomography (AS-OCT). Department of Ophthalmology, Royal Berkshire Hospital, Reading, United Kingdom. Clear corneal incisions in adult eyes were examined using a Visante AS-OCT imaging system within 1 hour of surgery. Half the CCIs had stromal hydration with a balanced salt solution and half did not. Incisions were made with a 2.75 mm steel keratome. Intraocular pressure (IOP) was measured within 90 minutes after surgery. The CCI length and corneal thickness at the CCI site were measured using software built into the AS-OCT system. Thirty CCIs were evaluated. Stromal hydration significantly increased the measured CCI length (Pthe result of a trend toward increased corneal thickness at the CCI site with hydration (PThe mean CCI length was 1.69 mm +/- 0.27 (SD) (range 1.31 to 2.32 mm) with hydration and 1.51 +/- 0.23 mm (range 1.30 to 1.95 mm) without hydration. The mean IOP was 20.9 +/- 8.18 mm Hg and 15.8 +/- 8.20 mm Hg, respectively. The IOP tended to be higher with hydration (Pthe eye with a higher early postoperative IOP, showing the importance of taking stromal hydration into account when designing similar OCT studies of CCI architecture.

Application of lift and squeeze technique in phacoemulsification of hypermature cataract

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Geng-Ying Li

2014-07-01

Full Text Available AIM: To evaluate the effectiveness and security of lift and squeeze technique in phacoemulsification of hypermature cataract.METHODS: From June 2010 to June 2013, totally 156 eyes with hypermature cataract, which received phacoemulsification in our hospital, were enrolled. Lift and squeeze technique was used to chop the nucleus, and 1g/L Trypan blue was used for capsulorhexis. Average time of phaco complication, corneal edema and visual outcome were recorded.RESULTS: The best-corrected visual acuity(BCVA was 0.1-0.4 in 15 eyes(9.6%, 0.5-0.7 in 82(52.6%eyes, and 0.8-1.0 in 59(37.8%eyes at 3mo after surgery. The phaco time was 25-56s(average 42±10s, the maximum phaco power was 30%. Posterior capsular rupture and vitreous loss happened in 2 eyes(1.3%, and the IOLs were implanted in the sulcus. Corneal edema classified at grade Ⅰ were seen in 12 eyes(7.7%, and 5 eyes(3.2%at gradeⅡ, no eye at grade Ⅲ and grade Ⅳ. The mean endothelial cell loss was 8.7% at 3mo.CONCLUSION: Crystalline lens capsule staining with Trypan blue increase the success rate of intact continuous curvilinear capsulorhexis(CCC. The lift and squeeze technique reduces the stress on the zonules and capsule, and decreases the phaco time and phaco power.

Goat's eye integrated with a human cataractous lens: A training model for phacoemulsification.

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Sengupta, Sabyasachi; Dhanapal, Praveen; Nath, Manas; Haripriya, Aravind; Venkatesh, Rengaraj

2015-03-01

A relatively simple and inexpensive technique to train surgeons in phacoemulsification using a goat's eye integrated with a human cataractous nucleus is described. The goat's eye is placed on a bed of cotton within the lumen of a cylindrical container. This is then mounted on a rectangular thermocol so that the limbus is presented at the surgical field. After making a clear corneal entry with a keratome, the trainer makes a 5-5.5 mm continuous curvilinear capsulorhexis in the anterior lens capsule, creates a crater of adequate depth in the cortex and inserts the human nucleus within this crater in the goat's capsular bag. The surgical wound is sutured, and the goat's eye is ready for training. Creating the capsulorhexis with precision and making the crater of adequate depth to snugly accommodate the human nucleus are the most important steps to prevent excessive wobbling of the nucleus while training.

Corneal Endothelial Safety of Intracameral Preservative-free 1% Xylocaine

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Shah Alpesh

2004-01-01

Full Text Available Purpose : To evaluate the effect of intracameral preservative-free 1% xylocaine on the corneal endothelium as an adjuvant to topical anaesthesia during phacoemulsification and Acrysof foldable IOL implantation. Material & Methods: This is a prospective, controlled, randomised, double-masked study. 106 patients with soft to moderately dense (Grade 1-3 senile cataract and corneal endothelial cell density of >1500/mm2 were randomised to the xylocaine group (n=53 and control group(n=53. Central endothelial specular microscopy and ultrasound corneal pachymetry were performed preoperatively. On the first postoperative day the eyes were evaluated for corneal oedema and Descemet′s folds. Ultrasound corneal pachymetry was performed at 1, 3 and 12 months. Specular microscopy was performed at 3 and 12 months. Cell loss was expressed as a percentage of preoperative cell density. Six patients could not complete one year follow-up. Chi-square and paired t test (2 tail statistical tests were applied for analysis. Results: Four (7.54% patients in the xylocaine group and 5 (9.43% in the control group had a few Descemet′s folds associated with mild central stromal oedema. Corneal thickness increased from 549.3µ ± 37.2µ to 555.5µ ± 36.5µ in the xylocaine group and from 553.1µ ± 36.2µ to 559.3µ ± 40.5µ in the control group at the one-month postoperative visit. Thickness returned to the preoperative level in xylocaine group 549.6µ ± 34.5µ and control group 554.7µ ± 41.1µ at three months. (P=0.484 The percentage of cell loss was 4.47 ± 2.53% in the xylocaine group and 4.49 ± 3.09 % in the control group at one year. (P=0.97 Conclusion: Intracameral preservative-free 1% xylocaine does not appear to affect corneal endothelium adversely during phacoemulsification.

Clinical experience of phacoemulsification for cataract patients with angle-closure glaucoma in 29 cases

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Yong-Hui Gu

2014-05-01

Full Text Available AIM: To observe the clinical effect of phacoemulsification with foldable intraocular lens implantation on cataract with angle-closure glaucoma. METHODS: Twenty-nine cases(29 eyesof angle-closure glaucoma with cataract underwent phacoemulsification with foldable intraocular lens implantation, and the data of visual acuity, intraocular pressure, gonioscopy and complications after operation were statistically analyzed.RESULTS:Postoperatively, 28 eyes(96.5%visual acuity were improved. Intraocular pressure of 25 eyes(86.2%were maintained at a normal level without any IOP lowering drug, intraocular pressure of 3 eyes(10.3%were controlled by IOP lowering eye drops, intraocular pressure of 1 eye(3.5%returned to normal by trabeculectomy. The chamber depth of 29 eyes was increased. 8 eyes were suffered from mild corneal edema, and returned to normal after treatment. CONCLUSION: Characterized by decreasing intraocular pressure, opening anterior chamber, and raising visual acuity, phacoemulsification with foldable intraocular lens implantation is a good operative therapy for primary angle-closure glaucoma complicated with cataract with preoperative goniosynechia closed ≤270°.

Comparison of biometric predictability and final refraction expected in phacoemulsification surgery with and without trabeculectomy

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Fernanda Guedes Oliveira

Full Text Available Abstract Objective: The main purpose of this article is to compare the predictability of biometric results and final refractive outcomes expected in patients undergoing cataract surgery through phacoemulsification with and without associated trabeculectomy. Methods: Cataract patients who have undergone phacoemulsification surgery alone (control group or associated with trabeculectomy (study group screened. All surgeries were performed following standard protocol. For enrollment, biometrics calculated by IOL Master (Carl Zeiss Meditec, Inc. biometry, refraction and intraocular pressure (IOP before and after surgery were required. Data was compared between groups in addition to the correlation between variation of IOP and final refraction. Results: Thirty eyes per group were enrolled. Only prior IOP (p <0.001, IOP post-surgery (p = 0.01 and the difference in IOP (p <0.001 were statistically significant. Axial length, IOL diopter used, expected spherical refraction by biometrics and astigmatism pre- and post-surgery were similar in both groups (p=0.1; 0.4; 0.4; 0.5 and 0.3, respectively. Spherical predictability by biometrics within 0.25 diopters was noted in both the control group (range 0.06 ± 0.45 and study group (range 0.25 ± 0.97, p = 0.3. There was no statistical significance between groups for the difference between final cylinder and corneal astigmatism (p = 0.9, and the difference between axis of refractive and corneal astigmatism (p = 0.7. Conclusion: The biometric predictability in phacoemulsification surgery and the expected final refraction are significant, andare not modified by trabeculectomy in the combined surgeries.

A clinical comparison of safety and efficacy in phacoemulsification with versus without ophthalmic viscoelastic device.

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Kugu, Suleyman; Erdogan, Gurkan; Sahin Sevim, M; Ozerturk, Yusuf

2015-03-01

To evaluate in a comparative manner the safety and efficacy of 1.0% sodium-Hyaluronate used during capsulorhexis and intraocular lens (IOL) implantation in phacoemulsification surgery. 1.0% sodium-Hyaluronate, which is commonly used as one of the ophthalmic viscoelastic devices, was compared to intraocular irrigating solution, which can bring up these effects. In addition, the effect of both methods on occurring corneal endothelial cell (CEC) loss was investigated. Each group comprised 19 eyes. The mean preoperative CEC density was 2525.68 ± 181.85 in Group H and 2514.16 ± 174.59 in Group V; no statistically significant difference was found between the groups (p > 0.05). Preoperative and postoperative first and twelfth week CEC densities were 2438.21 ± 198.12 (p  0.05). Although it was found that there was no statistically difference in terms of preventing CEC loss between 1.0% sodium-Hyaluronate and the irrigation method during phacoemulsification, it was observed clinically that 1.0% sodium-hyaluronate can make the procedure easy, safer, very helpful, especially for understanding phacoemulsification.

Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery

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Soliman Mahdy MAE

2012-03-01

Full Text Available Mohamed AE Soliman Mahdy1,2, Mohamed Z Eid1, Mahmoud Abdel-Badei Mohammed3, Amr Hafez4,5, Jagdish Bhatia21Ophthalmic Department, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt; 2Ophthalmic Department, Rustaq Hospital, Rustaq, Sultanate of Oman; 3Research Institute of Ophthalmology, Cairo, Egypt; 4Magrabi Eye and Ear Center, Muscat, Sultanate of Oman; 5Ophthalmic Department, Al-Azhar University Hospital, Assuit, EgyptPurpose: To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX in noncomplicated cataract surgery.Methods: In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts.Results: The study included 120 cases of age-related cataract whose mean age (standard deviation [SD] was 59.68 years (9.47. There was a highly statistically significant endothelial cell loss (P < 0.001. The endothelial cell loss ranged 11–1149 cells/mm2 with a median (interquartile range of 386 cells/mm2 (184.5–686 cells/mm2. The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range of 15.4% (7.2% to 26.8%. A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman’s rank-order correlation coefficient values, rho, (ρ were as follows: CDE (ρ = 0.425, aspiration time (ρ = 0.176, and volume (ρ = 0.278. Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall’s tau τ = 0.42.Conclusion: Microcoaxial phacoemulsification was efficient

Intraoperative performance and longterm outcome of phacoemulsification in age-related cataract.

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Dholakia Sheena

2004-01-01

Full Text Available PURPOSE: To evaluate intraoperative performance and longterm surgical outcome after phacoemulsification of age-related cataracts. METHODS: Prospective, observational, non-comparative study of 165 consecutive eyes undergoing phacoemulsification with nuclear sclerosis Grade I to III (Scale I to V. Preoperative evaluation included specular microscopy. Phacoemulsification was performed by a single surgeon using a standardised surgical technique under topical anaesthesia. Intraoperatively, effective phaco time (EPT, wound site thermal injury (WSTI, serious complications (eg. vitreous loss, posterior capsule rupture, zonulolysis and intraoperative posterior capsule opacification (plaque were evaluated. Postoperatively, posterior capsule opacification (PCO, Neodymium:YAG (Nd:YAG laser posterior capsulotomy rate, corneal endothelial count, best corrected visual acuity and cystoid macular oedema were evaluated. Eyes were examined at 6 months and then yearly for 3 years. RESULTS: Mean ages of 78 males and 87 females were 59.12 +/- 8.56 and 58.34 +/- 7.45 years respectively. EPT was 36 +/- 19 seconds and WSTI occurred in 7 eyes (4.7%. No serious intraocular complications occurred. Intraoperative posterior capsule opacification (plaque was present in 21 eyes (13.93%. Postoperatively, PCO occurred in 8 eyes (4.84% and Nd:YAG laser posterior capsulotomy was performed in 3 eyes (1.8%. Endothelial cell loss was 7.1% at 3 years follow-up. At the end of 3 years follow-up, 146 eyes (88.89% maintained a best corrected visual acuity of > or = 6/12. Cystoid macular oedema did not occur in any eye at 1 and 6 months′ follow-up. CONCLUSION: PCO rates and endothelial cell loss were acceptable. Consistent and reproducible outcome can be obtained after phacoemulsification of age related cataracts (grade I to III.

Goat′s eye integrated with a human cataractous lens: A training model for phacoemulsification

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Sabyasachi Sengupta

2015-01-01

Full Text Available A relatively simple and inexpensive technique to train surgeons in phacoemulsification using a goat′s eye integrated with a human cataractous nucleus is described. The goat′s eye is placed on a bed of cotton within the lumen of a cylindrical container. This is then mounted on a rectangular thermocol so that the limbus is presented at the surgical field. After making a clear corneal entry with a keratome, the trainer makes a 5-5.5 mm continuous curvilinear capsulorhexis in the anterior lens capsule, creates a crater of adequate depth in the cortex and inserts the human nucleus within this crater in the goat′s capsular bag. The surgical wound is sutured, and the goat′s eye is ready for training. Creating the capsulorhexis with precision and making the crater of adequate depth to snugly accommodate the human nucleus are the most important steps to prevent excessive wobbling of the nucleus while training.

Serial corneal endothelial cell loss with lathe-cut and injection-molded posterior chamber intraocular lenses.

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Kraff, M C; Sanders, D R; Lieberman, H L

1983-01-01

We compared endothelial cell loss of patients implanted with lathe-cut posterior chamber lenses and those implanted with injection-molded lenses over a three-year postoperative period. Results were based on more than 2,500 measurements of corneal endothelial density. Although the technique of cataract extraction (anterior chamber phacoemulsification, posterior chamber phacoemulsification, or planned extracapsular extraction) significantly affected cell loss (P less than .01), the type of implant (lathe-cut or injection-molded) did not. Significant continuing endothelial cell loss did not occur during the first three postoperative years with injection-molded lenses. There was, however, a statistically significant 7% to 15% additional cell loss after surgery over the first two to three postoperative years with lathe-cut implants. There have been no cases of corneal endothelial decompensation developing after implantation of injection-molded or lathe-cut lenses. Because a standard field clinical specular microscope was used in this study, cell counting errors cannot be ruled out as a cause of these findings.

An unusual complication of combined gonioscopy-assisted transluminal trabeculotomy and phacoemulsification: vision loss due to intracapsular hematoma.

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Yalinbas, Duygu; Aktas, Zeynep; Hepsen, İbrahim; Dilekmen, Nilay

2017-09-23

To report two cases with an acute vision loss due to intracapsular hemorrhage (hematoma) after an uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery. Case report. Seventy-six-year-old male and 75-year-old female patients with cataract and pseudoexfoliative glaucoma (XFG) uncontrolled with maximum medical therapy both underwent GATT combined with phacoemulsification. Shortly after the surgery, intracapsular hematoma behind the intraocular lens (IOL) were noted in both patients. Hematoma cleared in both of them via IOL extraction-anterior vitrectomy and YAG-laser capsulotomy, respectively. Hematoma cleared in both patients without any surgical complications. Vision loss due to unclearing intracapsular hematoma might be an early complication of combined GATT and phacoemulsification surgery.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

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Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (Ptransverse system vs torsional (Ptransverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Application of lens capsules tension reducing capsulorhexis and conventional capsulorhexis in the white cataract phacoemulsification

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Rong-Feng Liu

2017-09-01

Full Text Available Objective: To explore the clinical effect of lens capsules tension reducing capsulorhexis and conventional capsulorhexis in the white cataract phacoemulsification. Methods: A total of 68 patients (76 eyes with white cataract who were admitted in our hospital from June, 2011 to June, 2016 were included in the study and divided into the experiment group (n=34, 36 eyes and the control group (n=34, 40 eyes according to the difference of intraoperative capsulorhexis. All the patients were performed with cataract phacoemulsification in combined with intraocular lens implantation. The patients in the experiment group were performed with lens capsules tension reducing capsulorhexis, while the patients in the control group were performed with conventional capsulorhexis. The integrity of the anterior capsule capsulorhexis, the degree of corneal endothelium edema, the intraocular lens deviation, uncorrected visual acuity, and corneal endothelial cell count in the two groups were compared. Results: A total of 34 eyes (94.44% in the experiment group and 35 eyes (87.50% in the control group successfully completed continuous annular capsulorhexis, and there was no significant difference between the 2 groups. The number of patients whose uncorrected visual acuity was greater than 0.5 increased 1 d-6 months after operation, and that in the experiment group was significantly higher than that in the control group. The difference of intraocular lens deviation rates between the 2 groups at different times after operation was not significant. The corneal endothelial cell count 1 d-6 months after operation in the 2 groups was significantly decreased when compared with before operation, but the difference between the 2 groups was not significant. The number of eyes without edema in the experiment group 1d after operation was significantly higher than that in the control group, and the number of eyes with grade Ⅱ edema was significantly less than that in the control

Phacoemulsification in eyes with cataract and pseudoexfoliation syndrome

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Servet Cetinkaya

2016-06-01

Full Text Available AIM: To evaluate the visual outcomes and intraoperative and postoperative complications of phacoemulsification surgery in patients with cataract and pseudoexfoliation syndrome(PEXand the usage of proper surgical techniques and appropriate devices intraoperatively.METHODS: Sixty-seven eyes of 53 patients with PEX and cataract who had undergone phacoemulsification and intraocular lens(IOLimplantation surgery were evaluated retrospectively. The mean age was 71.68±9.96(53-89y, and there were 24(45%males and 29(55%females. Nuclear, cortical, posterior subcapsular, and mature cataracts were all represented.RESULTS: Nuclear cataract was significantly more common than other types(P=0.00. The mean preoperative best corrected visual acuity(BCVAwas 0.99±0.30(SD(0.40-1.50logMAR, and the mean postoperative BCVA was 0.32±0.31(SD(0.00-1.00logMAR(P=0.00. Iris retractors were used in 12(18%eyes. Capsular tension ring(CTRimplantation was used in 15(22%eyes, it was planned in 8(12%and unplanned in 7(10%. Posterior capsule rupture occurred in 4(6%eyes, and vitreous loss occurred in 2(3%eyes. Anterior vitrectomy was performed in these 2 eyes. Conversion to extracapsular cataract extraction(ECCEwas needed in these 2(3%eyes due to large posterior capsular rupture. Persistent corneal edema was observed in 4(6%eyes, and anterior chamber reaction in 5(7%eyes. IOL dislocation occurred in 4(6%eyes, but repositioning was only needed in 1(1.5%eye. Posterior capsule opacification(PCOrequiring Nd:YAG laser capsulotomy developed in 13(20%eyes.CONCLUSION: Postoperative visual acuities of patients with cataract and PEX are satisfactory. However, intraoperative and postoperative complications like posterior capsule rupture, vitreous loss, conversion to ECCE, persistent corneal edema, anterior chamber reaction and IOL dislocation may be observed. To avoid these complications, proper surgical techniques and the use of appropriate devices intraoperatively are essential.

Heat production: Longitudinal versus torsional phacoemulsification.

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Han, Young Keun; Miller, Kevin M

2009-10-01

To compare the heat production of longitudinal versus torsional phacoemulsification under strict laboratory test conditions. Department of Ophthalmology, David Geffen School of Medicine at UCLA, and Jules Stein Eye Institute, Los Angeles, California, USA. Two Infiniti phacoemulsification handpieces were inserted into silicone test chambers filled with a balanced salt solution and imaged serially using a thermal camera. Incision compression was simulated by suspending 25.3 g weights from the silicone chambers. To simulate occlusion of the phacoemulsification tip, the aspiration line was clamped. Peak temperatures were measured 0, 10, 30, 60, and 120 seconds after the commencement of continuous ultrasound power. The 2 handpieces, operating exclusively in longitudinal or torsional modes, were compared 3 ways: (1) using the same power displayed on the instrument console, (2) using identical stroke lengths, and (3) using the same applied energy, a product of stroke length and frequency. For all 3 comparisons, torsional phacoemulsification resulted in lower temperatures at each time point. At the same displayed power setting, the scenario most familiar to cataract surgeons, longitudinal phacoemulsification elevated temperatures up to 41.5 degrees C more than torsional phacoemulsification. Torsional phacoemulsification generated less heat than longitudinal phacoemulsification in all 3 comparison tests. Lower operating temperatures indicate lower heat generation within the same volume of fluid, and this may provide additional thermal protection during cataract surgery.

Evaluation of endothelial mucin layer thickness after phacoemulsification with next generation ophthalmic irrigating solution.

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Ghate, Deepta A; Holley, Glenn; Dollinger, Harli; Bullock, Joseph P; Markwardt, Kerry; Edelhauser, Henry F

2008-10-01

To evaluate human corneal endothelial mucin layer thickness and ultrastructure after phacoemulsification and irrigation-aspiration with either next generation ophthalmic irrigating solution (NGOIS) or BSS PLUS. Paired human corneas were mounted in an artificial anterior chamber, exposed to 3 minutes of continuous ultrasound (US) at 80% power using the Alcon SERIES 20000 LEGACY surgical system (n = 9) or to 2 minutes of pulsed US at 50% power, 50% of the time at 20 pps using the Alcon INFINITI Vision System (n = 5), and irrigated with 250 mL of either NGOIS or BSS PLUS. A control group of paired corneas did not undergo phacoemulsification or irrigation-aspiration (n = 5). Corneas were divided and fixed for mucin staining or transmission electron microscopy. Mucin layer thickness was measured on the transmission electron microscopy prints. The mucin layer thickness in the continuous phaco group was 0.77 +/- 0.02 microm (mean +/- SE) with NGOIS and 0.51 +/- 0.01 microm with BSS PLUS (t test, P INFINITI Vision System (pulsed US) and the LEGACY surgical system (continuous US).

Comparison of Endothelial Cell Loss by Specular Microscopy ...

African Journals Online (AJOL)

Endothelial cell loss was also compared in phacoemulsification group by temporal clear corneal incision (CCI) and by superior scleral incision (SI) technique. ..... vs manual sutureless small-incision extracapsular cataract surgery in Nepal.

Phacoemulsification and intraocular lens implantation in patients with oculocutaneous albinism.

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Dávila, Pedro J; Ulloa-Padilla, Jan P; Izquierdo, Natalio J

2017-01-01

To evaluate the benefits of phacoemulsification and intraocular lens implantation in patients with oculocutaneous albinism (OCA). The charts of 195 patients with OCA who visited a local eye clinic were reviewed. All of these patients had genetic linkage analysis to establish OCA type. Frequencies and Paired t-test analysis were determined. Of the 195 patients, nine (4.6%) underwent clear cornea phacoemulsification with intraocular lens implantation. Seven of the nine patients with OCA had the Hermansky-Pudlak (HPS) type 1; two had OCA type 1. Pre-operative BCVA of all eyes ranged from 1.0 to 2.3 logMAR with a mean of 1.42 logMAR and a standard deviation of 0.41 logMAR. Post-operative BCVA of all eyes ranged from 1.0 to 1.30 logMAR with a mean of 1.04 logMAR and a standard deviation of 0.10 logMAR. BCVA improved after phacoemulsification surgery and intraocular lens implantation (p = 0.002). Pre-operative astigmatism of all eyes ranged from +0.50 to +5.75 with a mean of +2.25 and a standard deviation of +2.40. Post-operative astigmatism of all eyes ranged from +0.50 to +2.00 with a mean of +1.23 and a standard deviation of +0.42. Astigmatism improved after phacoemulsification surgery and intraocular lens implantation (p = 0.05). Nine patients with OCA who underwent phacoemulsification and intraocular lens implant experienced improved visual acuity and reduced astigmatism post-operatively. These results suggest cataract surgery may improve vision and refractive errors, and thus quality of life, in patients with albinism.

Curative effects of small incision cataract surgery versus phacoemulsification: a Meta-analysis

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Chang-Jian Yang

2013-08-01

Full Text Available AIM: To evaluate the curative efficacy of small incision cataract surgery(SICSversus phacoemulsification(Phaco.METHODS: A computerized literature search was carried out in Chinese Biomedical Database(CBM, Wanfang Data, VIP and Chinese National Knowledge Infrastructure(CNKIto collect articles published between 1989-2013 concerning the curative efficacy of SICS versus Phaco. The studies were assessed in terms of clinical case-control criteria. Meta-analysis were performed to assess the visual acuity, the complications rates between SICS and Phaco 90 days after surgery. Treatment effects were measured as risk difference(RDbetween SICS and Phaco. Fixed and random effect models were employed to combine results after a heterogeneity test. RESULTS:A total of 8 studies were included in our Meta-analysis. At 90 days postoperative time, there were no significant differences between the two groups at the visual acuity >0.5(P=0.14; and no significant differences on the complications rates of corneal astigmatism, corneal edema, posterior capsular rupture and anterior iris reaction(P>0.05.CONCLUSION: These results suggest that there is no different on the curative effects of SICS and Phaco for cataract.

Comparison of peristaltic and Venturi pumps in bimanual microincisional cataract surgery.

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Karaguzel, Hande; Karalezli, Aylin; Aslan, Bekir Sitki

2009-12-01

Comparison of peristaltic and Venturi pumps in bimanual microincision phacoemulsification on the success of the cataract surgery by using sleeveless phaco tip. Bimanual microincision phacoemulsification was done in 49 eyes using a 1.4-mm temporal clear corneal incision. A peristaltic pump was used in 23 eyes, and a Venturi pump was used in 26 eyes for phacoemulsification. Intraoperative complications, anterior chamber stability, and mean duration of surgery were recorded. Duration of surgery was shorter in the Venturi pump group. Anterior chamber stability could not be established in 17 eyes in the peristaltic pump group; it was established in all eyes in the Venturi pump group. Corneal burns were observed in two eyes in the peristaltic pump group and no eyes in the Venturi pump group. Use of a Venturi pump system and a vented gas-forced infusion system can significantly shorten surgery time and reduce risk of thermal burns.

Effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy

OpenAIRE

Lei Zhan; Si-Ying Xiong; Meng-Xin Gan; Li-Hui Wen

2017-01-01

AIM: To investigate the effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy. METHODS: A retrospective study was designed. 160 patients(160 eyes)with diabetic retinopathy from Jan 2015 to Feb 2017 were divided into two groups according to cataract. 74 patients(74 eyes)were operated on vitrectomy, and 86 patients(86 eyes)on vitrectomy combined with phacoemulsification cataract surgery and capsular bag implantation of foldable intraocular...

Effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy

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Lei Zhan

2017-08-01

Full Text Available AIM: To investigate the effects of vitrectomy combined with cataract surgery on the corneal endothelial cells in diabetic retinopathy. METHODS: A retrospective study was designed. 160 patients(160 eyeswith diabetic retinopathy from Jan 2015 to Feb 2017 were divided into two groups according to cataract. 74 patients(74 eyeswere operated on vitrectomy, and 86 patients(86 eyeson vitrectomy combined with phacoemulsification cataract surgery and capsular bag implantation of foldable intraocular lens. To record the change of corneal endothelial cells density, average cellular area, coefficient of variation and percentage of hexagonal endothelial cell before and after treatment with Topcon corneal specular microscope. RESULTS: Before and after surgery, the results of corneal endothelial cells density, average cellular area, coefficient of variation and percentage of hexagonal endothelial cell in simple vitrectomy group were no significant difference(P>0.05; After treatment corneal endothelial cells density and percentage of hexagonal endothelial cell were changed with statistical difference as the same as average cellular area and coefficient of variation(PPCONCLUSION: It has certain influence on the corned endothelial cells when using vitrectomy combined with cataract surgery in diabetic retinopathy. For patients with indications, it should be paid attention to protecting the corneal endothelial cells.

[Influence AquaLase at corneal endothelial cells].

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Jirásková, N; Rozsíval, P; Ludvíková, M; Burova, M; Nekolová, J

2009-07-01

To assess the effect of the cleaning of the posterior capsule using pulses of balanced salt solution (BSS) on the corneal endothelial cells. This pilot study involves 43 patients with bilateral cataracts having lens removal using torsional phacoemulsification (Ozil, Infiniti, Alcon) and bimanul irrigation/aspiration (I/A). Posterior capsule of the right eye of each patient was cleaned using pulses of BSS (AquaLase, Infiniti, Alcon). Surgery was performed by one of 2 surgeons (NJ, PR), both eyes of each patient was operated on by the same surgeon. Best corrected visual acuity (BCVA), endotelial cell count and pachymetry were evaluated pre- and postoperatively as well as occurence af peri- and postoperative complications. Preoperative mean pachymetry (P) was 566 +/- 45 microm in the right eye (RE) and 562 +/- 42 microm in the left eye (LE), mean endotelial cell count (ECC) 2541 +/- 317 cells/mm2 (RE) and 2567 +/- 311 cells/mm2 (LE). Three months after surgery P was 557 +/- 43 microm (RE) and 558 +/- 45 microm (LE) and ECC 2368 +/- 416 cells/mm2 (RE) and 2396 +/- 417 cells/mm2 (LE). There was no statistical difference in postoperative changes of both corneal parameters between right and left eyes. Best corrected visual acuity improved in all eyes and no peri-or postoperative complications occured. Cleaning of the posterior capsule using AquaLase is safe for corneal endothelial cells.

Clinical research of phacoemulsification with posterior chamber intraocular lens implantation for glaucoma with different goniosynechia ranges

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Qing-Yu Li

2016-02-01

Full Text Available AIM:To study the effect of phacoemulsification with posterior chamber intraocular lens implantation to treat glaucoma with different angle-closure range, which may provide a better way to treat the angle-closure glaucoma.METHODS:There were 47 cases(54 eyeswith angle-closure glaucoma, and all of them underwent phacoemulsification and posterior chamber intraocular lens implantation. According to the range of goniosynechia, these patients were divided into three groups:the eyes with the range of goniosynechia≤1/2 were group A(13 eyes; the eyes with 1/23/4 were group C(23 eyes. We observed the status of anterior chamber angle and the intraocular pressure(IOPof the three groups at 2wk after operations. RESULTS:Compared to the preoperative condition, the IOP of the three groups at 2wk after operations decreased significantly. The IOP reductions of group B and C were more significant than that of group A, and the differences were significant(PPP3/4 appeared in group B; in group C, there were 5 eyes with goniosynechia>3/4, 1 eye with disappeared anterior chamber, 3 eyes with corneal edema, 1 eye with choroidal hemorrhage. The differences of postoperative complication rate among the three groups was statistically significant(PPCONCLUSION:For patients with angle closure glaucoma who have mild to moderate goniosynechia, phacoemulsification with posterior chamber intraocular lens implantation is an effective way. After operations, their closed anterior angle reopened. But to the patients with severe adhesions, there are more complications after operations, especially the glaucoma may reoccur.

Efficacy of different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation

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Yu-Xia Ruan

2017-09-01

Full Text Available AIM: To explore efficacy of the different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation.METHODS: Totally 280 patients(280 eyeswith xerophthalmia after operation in our hospital from January 2015 to June 2016 were selected. According to the different treatment methods, they were divided into control group(n=70; treated with tobramycin and dexamethasone eye ointment 3 times per day for 1wk, levofloxacin eye drops 3 times per day for 1wk, pranoprofen eye drops 4 times per day for 1mo, polyacrylic acid group(n=70; besides the treatment of control group, polyacrylic acid was used 4 times per for 1mo, polyethylene glycol group(n=70; besides the treatment of control group, polyethylene glycol was used 4 times per for 1moand sodium hyaluronate group(n=70; besides the treatment of control group, sodium hyaluronate was used 4 times per for 1mo. The tear film break up time(BUT, Schirmer Ⅰ test(SⅠt, symptoms of dry eye and corneal staining in four groups were observed. RESULTS:(1BUT: The BUT of the four groups significantly increased after treatment(PPPPPPPPPPP>0.05; sodium hyaluronate group was significant lower than other groups in corneal staining score at 3wk and 1mo after treatment(PCONCLUSION: Artificial tears in the treatment of xerophthalmia after cataract phacoemulsification combined with intraocular lens implantation has better clinical efficacy, which contains sodium hyaluronate may be the better than others.

Application and experience of anterior vitrectomy in phacoemulsification

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Xiao-Bo Zeng

2016-02-01

Full Text Available AIM: To observe and discuss the clinical application and effect of anterior vitrectomy in phacoemulsification for the treatment of vitreous prolapse caused by posterior capsular rupture or suspensory ligament transection.METHODS:Retrospective analysis of 28 cases(35 eyeswith cataract in whom vitreous prolapse caused by posterior capsular rupture or suspensory ligament transection occurred in phacoemulsification and intraocular lens implantation and anterior vitrectomy were performed was conducted. RESULTS:Anterior vitrectomy for timely and accurate treatment for vitreous prolapse caused by posterior capsular rupture or suspensory ligament transection occurred in phacoemulsification was satisfied. CONCLUSION: Anterior vitrectomy has good curative effect for vitreous prolapse caused by posterior capsular rupture or suspensory ligament transection occurred in phacoemulsification and is effective with less severe complications.

Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation

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Schulze SD

2015-11-01

Full Text Available Stephan D Schulze,1 Thomas Bertelmann,1 Irena Manojlovic,2 Stefan Bodanowitz,2 Sebastian Irle,3 Walter Sekundo11Department of Ophthalmology, Philipps University of Marburg, Marburg, 2Private Practice and Ambulatory Surgical Center, Bremen, 3Freelance Statistician, Friedberg, GermanyPurpose: To evaluate whether the use of balanced salt solution (BSS or an ophthalmic viscoelastic device (OVD during hydrophilic acrylic intraocular lens (IOL implantation variously impacts corneal endothelial cell characteristics in eyes undergoing uneventful phacoemulsifications.Methods: Prospective nonrandomized observational clinical trial. Patients were assigned either to the BSS plus® or to the OVD Z-Celcoat™ group depending on the substance used during IOL implantation. Corneal endothelium cell characteristics were obtained before, 1 week, and 6 weeks after surgery. Intraoperative parameters (eg, surgery time, phacoemulsification energy were recorded.Results: Ninety-seven eyes were assigned to the BSS plus and 86 eyes to the Z-Celcoat group. Preoperative corneal endothelium cell density (ECD and endothelium cell size were 2,506±310 cells/mm2/2,433±261 cells/mm2 and 406±47 µm2/416±50 µm2 (P=0.107/P=0.09. After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001 without significant differences between both groups (each P>0.05. Irrigation–aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes were significantly longer in the OVD Z-Celcoat group (each P<0.001. No complications or serious side effects occurred.Conclusion: Implantation of a hydrophilic acrylic IOL under BSS infusion seems to be a useful and faster alternative in experienced hands without generating higher ECD loss rates.Keywords: phacoemulsification, ophthalmic viscoelastic device, endothelial cell density, IOL

Intravitreal Phacoemulsification Using Torsional Handpiece for Retained Lens Fragments

OpenAIRE

Kumar, Vinod; Takkar, Brijesh

2016-01-01

Purpose: To evaluate the results of intravitreal phacoemulsification with torsional hand piece in eyes with posteriorly dislocated lens fragments. Methods: In this prospective, interventional case series, 15 eyes with retained lens fragments following phacoemulsification were included. All patients underwent standard three-port pars plana vitrectomy and intravitreal phacoemulsification using sleeveless, torsional hand piece (OZiL™, Alcon's Infiniti Vision System). Patients were followed up...

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract.

Science.gov (United States)

Fakhry, Mohamed A; El Shazly, Malak I

2011-01-01

To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

DYNAMIC CHANGES OF THE POSTERIOR POLE OF THE EYE AFTER CATARACT PHACOEMULSIFICATION WITH INTRAOCULAR LENS IMPLANTATION

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M. Р. Yugay

2017-01-01

Full Text Available Objective. To study the effect of uncomplicated phacoemulsification through the corneal incision with implantation of the intraocular lens (IOL for changes in the macular region of the retina. Methods: The study included 35 eyes of 35 patients who underwent uncomplicated phacoemulsification with IOL implantation. The average age of the patients was 67±2,3 years, among them were 19 women and 16 men. Exclusion criteria: retinal pathology (postthrombotic and diabetic retinopathy, wet form of age-related macular degeneration and other diseases of the retina, previous eye injuries, uveitis, intra-operative complications. Retinal thickness in the fovea, the macula, and macular volume were measured by optical coherence tomography on the first day, after 2 weeks, 1 and 3 months after surgery. Results. In the period between the first day and two weeks after surgery there were the statistically significant incensement in retinal thickness in the macula from 306,64±21,15 mkm to 321,46±27,83 mkm (p <0.05, in the fovea from 211,45±20,24 mkm to 218,69±17,84 mkm (p<0.05, macular volume from 8,08±0,35 cubic mm to 8,46±0,54 cubic mm were registered. By the end of the first month after surgery maximum retinal thickness was 327,23±27,16 mkm, thickness in the fovea 220,31±18,63 mkm, macular volume 8,61±0,55 cubic mm. After 3 months, the maximum thickness of the retina reached 325,11±26,13 mkm, in the fovea 220,31±18,63 mkm, macular volume 8,55±0,49 cubic mm. Conclusion. There was an incensement of macular volume and retinal thickness in the period between the first day and two weeks after uncomplicated cataract phacoemulsification with intraocular lens implantation. The growth of these indicators continued within the first month after surgery, three months after phacoemulsification there was a downward trend. This can be important in determining the duration of drug therapy in the postoperative period.

[Phacoemulsification of subluxated lens with capsular tension ring implantation].

Science.gov (United States)

Dorecka, Mariola; Rokicki, Wojciech; Nita, Malgorzata; Krysik, Katarzyna; Nita, Ewa; Sikorska, Aleksandra; Romaniuk, Wanda

2007-01-01

To evaluate long term results of phacoemulsification with PC IOL and capsular tension ring (CTR) implantation in lens subluxation. The study comprised of 134 patients--146 eyes with subluxated lens. In all cases phacoemulsification with PC IOL and CTR implantation was performed. No intaroperative complications has occured. Postoperative complications included: inflammation in the anterior chamber in 3 eyes (2.1%), retinal detachment in 2 eyes (1.4%). In all cases there was no PC IOL decentration. (1) CTR facilitates phacoemulsification with PC IOL implantation in lens subluxation. (2) Phacoemulsification of subluxated lens with PC IOL and CTR implantation seems to be safe and effective procedure.

Intravitreal Phacoemulsification Using Torsional Handpiece for Retained Lens Fragments.

Science.gov (United States)

Kumar, Vinod; Takkar, Brijesh

2016-01-01

To evaluate the results of intravitreal phacoemulsification with torsional hand piece in eyes with posteriorly dislocated lens fragments. In this prospective, interventional case series, 15 eyes with retained lens fragments following phacoemulsification were included. All patients underwent standard three-port pars plana vitrectomy and intravitreal phacoemulsification using sleeveless, torsional hand piece (OZiL™, Alcon's Infiniti Vision System). Patients were followed up for a minimum of six months to evaluate the visual outcomes and complications. The preoperative best-corrected visual acuity (BCVA) ranged from light perception to 0.3. No complications such as thermal burns of the scleral wound, retinal damage due to flying lens fragments, or difficult lens aspiration occurred during intravitreal phacoemulsification. Mean post-operative BCVA at the final follow-up was 0.5. Two eyes developed cystoid macular edema, which was managed medically. No retinal detachment was noted. Intravitreal phacoemulsification using torsional hand piece is a safe and effective alternative to conventional longitudinal phacofragmentation.

Intravitreal Phacoemulsification Using Torsional Handpiece for Retained Lens Fragments

Science.gov (United States)

Kumar, Vinod; Takkar, Brijesh

2016-01-01

Purpose: To evaluate the results of intravitreal phacoemulsification with torsional hand piece in eyes with posteriorly dislocated lens fragments. Methods: In this prospective, interventional case series, 15 eyes with retained lens fragments following phacoemulsification were included. All patients underwent standard three-port pars plana vitrectomy and intravitreal phacoemulsification using sleeveless, torsional hand piece (OZiL™, Alcon's Infiniti Vision System). Patients were followed up for a minimum of six months to evaluate the visual outcomes and complications. Results: The preoperative best-corrected visual acuity (BCVA) ranged from light perception to 0.3. No complications such as thermal burns of the scleral wound, retinal damage due to flying lens fragments, or difficult lens aspiration occurred during intravitreal phacoemulsification. Mean post-operative BCVA at the final follow-up was 0.5. Two eyes developed cystoid macular edema, which was managed medically. No retinal detachment was noted. Conclusion: Intravitreal phacoemulsification using torsional hand piece is a safe and effective alternative to conventional longitudinal phacofragmentation. PMID:27621783

Facoemulsificação por córnea clara no meridiano mais curvo Phacoemulsification using clear cornea incision in steepest meridian

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Fernando Pistarini Gonçalves

2007-03-01

Full Text Available OBJETIVOS: Avaliar o efeito da facoemulsificação com incisão em córnea clara no meridiano mais curvo sobre a magnitude do astigmatismo ceratométrico pré-operatório. Mapear a magnitude do astigmatismo cirurgicamente induzido por incisões nas posições nasal (N, temporal (T, temporal superior (TS e temporal inferior (TI. MÉTODOS: Foi realizado estudo ceratométrico prospectivo em 48 olhos de 48 pacientes, submetidos a facoemulsificação com incisão do meridiano mais curvo. As medidas ceratométricas foram realizadas no pré-operatório e um mês após a realização da cirurgia. O astigmatismo cirurgicamente induzido foi determinado pelo método das coordenadas retangulares em 10 passos, modificado. RESULTADOS: Foram operados 21 olhos direitos e 27 olhos esquerdos e, de acordo com a posição das incisões em córnea clara, foram divididos em: 16 olhos N, 4 olhos T, 22 olhos TS, 6 olhos TI. A média da ametropia cilíndrica pré-operatória foi de 1,06D ± 0,65 e a pós-operatória de 0,89D ± 0,80. Houve diminuição estatisticamente significativa no astigmatismo corneal preexistente (p=0,016. A média total de astigmatismo cirurgicamente induzido foi de 0,94D ± 0,56. Em relação aos grupos o astigmatismo cirurgicamente induzido foi de 1,06D ± 0,66 em N, 0,87D ± 0,20 em T, 0,95D ± 0,55 em TS e 0,61D ± 0,25 em TI. Não houve diferença estatística com relação ao astigmatismo cirurgicamente induzido nos grupos N, T, TS e TI (p=0,426. CONCLUSÃO: A técnica se mostrou efetiva na redução do astigmatismo ceratométrico pré-operatório. A média do astigmatismo cirurgicamente induzido foi de 1,06D ± 0,66 em N, 0,95D ± 0,55 em TS, 0,61D ± 0,25 em T e 0,87D ± 0,20 em TI.PURPOSE: To evaluate the effect of phacoemulsification through clear cornea incision in the steepest meridian (ISM, on the magnitude of preoperative keratometric astigmatism. To map the magnitude of surgically induced astigmatism (SIA by clear cornea incision

Phacoemulsification tip vacuum pressure: Comparison of 4 devices.

Science.gov (United States)

Payne, Marielle; Georgescu, Dan; Waite, Aaron N; Olson, Randall J

2006-08-01

To determine the vacuum pressure generated by 4 phacoemulsification devices measured at the phacoemulsification tip. University ophthalmology department. The effective vacuum pressures generated by the Sovereign (AMO), Millennium (Bausch & Lomb), Legacy AdvanTec (Alcon Laboratories), and Infiniti (Alcon Laboratories) phacoemulsification machines were measured with a device that isolated the phacoemulsification tip in a chamber connected to a pressure gauge. The 4 machines were tested at multiple vacuum limit settings, and the values were recorded after the foot pedal was fully depressed and the pressure had stabilized. The AdvanTec and Infiniti machines were tested with and without occlusion of the Aspiration Bypass System (ABS) side port (Alcon Laboratories). The Millennium machine was tested using venturi and peristaltic pumps. The machines generated pressures close to the expected at maximum vacuum settings between 100 mm Hg and 500 mm Hg with few intermachine variations. There was no significant difference between pressures generated using 19- or 20-gauge tips (Millennium and Sovereign). The addition of an ABS side port decreased vacuum by a mean of 12.1% (P < .0001). Although there were some variations in vacuum pressures among phacoemulsification machines, particularly when an aspiration bypass tip was used, these discrepancies are probably not clinically significant.

Thermal imaging comparison of Signature, Infiniti, and Stellaris phacoemulsification systems.

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Ryoo, Na Kyung; Kwon, Ji-Won; Wee, Won Ryang; Miller, Kevin M; Han, Young Keun

2013-10-12

To compare the heat production of 3 different phacoemulsification machines under strict laboratory test conditions. More specifically, the thermal behavior was analyzed between the torsional modality of the Infiniti system and longitudinal modalities of the Abbot WhiteStar Signature Phacoemulsification system and Bausch and Lomb Stellaris system. Experiments were performed under in-vitro conditions in this study.Three phacoemulsification handpieces (Infiniti, Signature, and Stellaris) were inserted into balanced salt solution-filled silicone test chambers and were imaged side-by-side by using a thermal camera. Incision compression was simulated by suspending 30.66-gram weights from the silicone chambers. The irrigation flow rate was set at 0, 1, 2, 3, 4, and 5 cc/min and the phacoemulsification power on the instrument consoles was set at 40, 60, 80, and 100%. The highest temperatures generated from each handpiece around the point of compression were measured at 0, 10, 30, and 60 seconds. Under the same displayed phacoemulsification power settings, the peak temperatures measured when using the Infiniti were lower than when using the other two machines, and the Signature was cooler than the Stellaris. At 10 seconds, torsional phacoemulsification with Infiniti at 100% power showed data comparable to that of the Signature at 80% and the Stellaris at 60%. At 30 seconds, the temperature from the Infiniti at 100% power was lower than the Signature at 60% and the Stellaris at 40%. Torsional phacoemulsification with the Infiniti generates less heat than longitudinal phacoemulsification with the Signature and the Stellaris. Lower operating temperatures indicate lower heat generation within the same fluid volume, which may provide additional thermal protection during cataract surgery.

Quantification of hydroxyl radical produced during phacoemulsification.

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Gardner, Jonathan M; Aust, Steven D

2009-12-01

To quantitate hydroxyl radicals produced during phacoemulsification with various irrigating solutions and conditions used in cataract surgery. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. All experiments were performed using an Infiniti Vision System phacoemulsifier with irrigation and aspiration. Hydroxyl radicals were quantitated using electron spin resonance spectroscopy and a spectrophotometric assay for malondialdehyde, which is formed by the oxidation of deoxyribose by the hydroxyl radical. Hydroxyl radical production increased during longitudinal-stroking phacoemulsification as power levels were increased in a nonlinear, nonexponential fashion. The detection of hydroxyl radical was reduced in irrigating solutions containing organic molecules (eg, citrate, acetate, glutathione, dextrose) and further reduced in Navstel, an irrigating solution containing a viscosity-modifying agent, hydroxypropyl methylcellulose. Hydroxyl radicals produced in settings representative of those used in phacoemulsification cataract surgery were quantitated using the deoxyribose method. Hydroxyl radical production was dependent on the level of ultrasound power applied and the irrigating solution used. Oxidative stress on the eye during phacoemulsification may be minimized by using irrigating solutions that contain organic molecules, including the viscosity-modifying agent hydroxypropyl methylcellulose, that can compete for reaction with hydroxyl radicals.

Evaluation of tensile strength of tissue adhesives and sutures for clear corneal incisions using porcine and bovine eyes, with a novel standardized testing platform

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Kaja S

2012-02-01

Full Text Available Simon Kaja, Daryl L Goad, Fatima Ali, Ashley Abraham, R Luke Rebenitsch, Savak Teymoorian, Rohit Krishna, Peter KoulenVision Research Center and Department of Ophthalmology, University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USABackground: Tissue adhesives for ophthalmologic applications were proposed almost 50 years ago, yet to date no adequate tissue glues have been identified that combine strong sealing properties with adequate safety and absence of postsurgical side effects. In recent years, cataract surgeries and Descemet's stripping with endothelial keratoplasty procedures have significantly increased the number of clear corneal incisions performed. One of the obstacles to discovery and development of novel tissue adhesives has been the result of nonstandardized testing of potential tissue glues.Methods: We developed an instrument capable of controlling intraocular pressure in explanted porcine and bovine eyes in order to evaluate sealants, adhesives, and surgical closure methods used in ophthalmic surgery in a controlled, repeatable, and validated fashion. We herein developed and validated our instrument by testing the adhesive properties of cyanoacrylate glue in both porcine and bovine explant eyes.Results: The instrument applied and maintained intraocular pressure through a broad range of physiological intraocular pressures. Cyanoacrylate-based glues showed significantly enhanced sealing properties of clear corneal incisions compared with sutured wounds.Conclusion: This study shows the feasibility of our instrument for reliable and standardized testing of tissue adhesive for ophthalmological surgery.Keywords: manometer, intraocular pressure, applanation tonometry, clear corneal incision, tissue adhesive, ocular surgery

Single versus Two-Site Phacoemulsification and Mitomycin-C Trabeculectomy

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Alireza Baradaran-Rafiee

2008-11-01

Full Text Available

PURPOSE: To compare the outcomes of single-site versus two-site mitomycin-C (MMC augmented phacotrabeculectomy. METHODS: This matched randomized clinical trial included 34 eyes of 30 patients with visually significant cataracts and poorly controlled glaucoma. Equal numbers of eyes were randomly assigned to the single-site and two-site groups. In the single-site approach, phacoemulsification was performed under a superior scleral tunnel followed by trabeculectomy. The two-site approach included a temporal clear corneal phaco-emulsification combined with a separate superior trabeculectomy. MMC 0.2 mg/ml was similarly applied for one minute in both groups. RESULTS: Patients were followed for a mean period of 13±1.4 (range, 12 to 15 months. Mean best corrected visual acuity one year after surgery was 0.6±0.4 LogMAR in the single-site group and 0.4±0.28 LogMAR in the two-site group (P=0.12. In the single-site group, mean preoperative intraocular pressure (IOP was 26.4±6.6 mmHg which was decreased to 14.8±2.5 mmHg, one year after the operation (P < 0.001. Corresponding figures for the two-site group were 22.9±3.3 and 13.6±1.7 mmHg respectively (P < 0.001. At final follow up no significant difference in IOP existed between the study groups. Mean number of anti-glaucoma medications was 0.06±0.24 in the two-site group vs 0

Microscopia confocal de la córnea en facoemulsificación Confocal microscopy of the cornea on phacoemulsification

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Juan Raúl Hernández Silva

2011-12-01

Full Text Available Objetivo: Determinar los cambios estructurales de la córnea en la cirugía de catarata por facoemulsificación sin complicaciones. Métodos: Se realizó un estudio prospectivo de pacientes operados de catarata por facoemulsificación coaxial por la técnica de pre chop sin complicaciones. A estos se les realizó microscopia confocal de la córnea con el CONFOSCAN 4 (Nidek Technologies con el objetivo de 40x y adaptador Z-Ring. Se realizó el estudio en el preoperatorio y en el posoperatorio (a las 24 horas, después de una semana, de un mes y a los tres meses. Resultados: Se demostraron cambios estructurales en la córnea como células epiteliales con núcleos hiperreflectivos alargadas en ocasiones y áreas de hiperreflectividad anómala a las 24 horas del posoperatorio. Persistieron queratocitos activados y la disminución de la hiperreflectividad de la matriz extracelular que desapareció al mes. Conclusiones: Aunque por biomicroscopia no se observen alteraciones corneales en el posoperatorio de la cirugía de catarata por facoemulsificación, sí se pueden demostrar por microscopia confocal de la córnea. Estas variaciones no influyen en la recuperación visual óptima de los pacientes.Objective: To determine the structural changes in the cornea in the cataract surgery using phacoemulsification without complications. Methods: A prospective study of patients operated on from cataract using the coaxial phacoemulsification (Pre Chop technique without complications was carried out. These patients also underwent confocal microscopy of the cornea with Confoscan4 (Nidek Technologies with 40x target and Z - Ring adapter. The study was performed in the preoperative period and postoperative period for 24 hours, one week, one month and three months after surgery. Results: Structural changes were observed in the cornea such as epithelial cells with hypereflectivity nucleus, occasionally elongated, , areas of anomalous hypereflectivity 24 hours after

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems.

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Chen, Ming; Anderson, Erik; Hill, Geoffrey; Chen, John J; Patrianakos, Thomas

2015-01-01

To compare cumulative dissipated energy between two phacoemulsification machines. An ambulatory surgical center, Honolulu, Hawaii, USA. Retrospective chart review. A total of 2,077 consecutive cases of cataract extraction by phacoemulsification performed by five surgeons from November 2012 to November 2014 were included in the study; 1,021 consecutive cases were performed using the Infiniti Vision System, followed by 1,056 consecutive cases performed using the Centurion Vision System. The Centurion phacoemulsification system required less energy to remove a cataractous lens with an adjusted average energy reduction of 38% (5.09 percent-seconds) (PInfiniti phacoemulsification system. The reduction in cumulative dissipated energy was statistically significant for each surgeon, with a range of 29%-45% (2.25-12.54 percent-seconds) (P=0.005-Infiniti and Centurion systems varied directly with patient age, increasing an average of 2.38 percent-seconds/10 years. The Centurion phacoemulsification system required less energy to remove a cataractous lens in comparison to the Infiniti phacoemulsification system.

Healed corneal ulcer with keloid formation.

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Alkatan, Hind M; Al-Arfaj, Khalid M; Hantera, Mohammed; Al-Kharashi, Soliman

2012-04-01

We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman's layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a corneal keloid which was supported by further ultrastructural study. The corneal graft remained clear 6 months after surgery and the patient was satisfied with the visual outcome. Penetrating keratoplasty may be an effective surgical option for corneal keloids in young adult patients.

[Computer-assisted phacoemulsification for hard cataracts].

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Zemba, M; Papadatu, Adriana-Camelia; Sîrbu, Laura-Nicoleta; Avram, Corina

2012-01-01

to evaluate the efficiency of new torsional phacoemulsification software (Ozil IP system) in hard nucleus cataract extraction. 45 eyes with hard senile cataract (degree III and IV) underwent phacoemulsification performed by the same surgeon, using the same technique (stop and chop). Infiniti (Alcon) platform was used, with Ozil IP software and Kelman phaco tip miniflared, 45 degrees. The nucleus was split into two and after that the first half was phacoemulsificated with IP-on (group 1) and the second half with IP-off (group 2). For every group we measured: cumulative dissipated energy (CDE), numbers of tip closure that needed manual desobstruction the amount of BSS used. The mean CDE was the same in group 1 and in group 2 (between 6.2 and 14.9). The incidence of occlusion that needed manual desobstruction was lower in group 1 (5 times) than in group 2 (13 times). Group 2 used more BSS compared to group 1. The new torsional software (IP system) significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts.

Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery.

LENUS (Irish Health Repository)

Dooley, I

2012-02-01

PURPOSE: To study changes in anterior segment morphometry after uneventful phacoemulsification cataract surgery, and to investigate whether there is a relationship between any observed changes and intraocular pressure (IOP) reduction after the procedure. METHODS: The anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), and IOP were measured in 101 non-glaucomatous eyes before and after uneventful phacoemulsification cataract surgery. RESULTS: After cataract surgery, the mean ACD, ACV, and ACA values increased by 1.08 mm, 54.4 mm(3), and 13.1 degrees , respectively, and the mean IOP (corrected for CCT) decreased by 3.2 mm Hg. The predictive value of a previously described index (preoperative ACD\\/preoperative IOP (corrected for CCT) or CPD ratio) for IOP (corrected for CCT) reduction after cataract surgery was confirmed, reflected in an r(2) value of 23.3% between these two parameters (P<0.001). Other indices predictive of IOP reduction after cataract surgery were also identified, including preoperative IOP\\/preoperative ACV and preoperative IOP\\/preoperative ACA, reflected in r(2) values of 13.7 and 13.7%, respectively (P<0.001 and P<0.001, respectively). CONCLUSIONS: Our study confirms the predictive value of the CPD ratio for IOP reduction after cataract surgery, and may contribute to the decision-making process in patients with glaucoma or ocular hypertension. Furthermore, two novel indices of preoperative parameters that are predictive for IOP reduction after cataract surgery were identified, and enhance our understanding of the mechanisms underlying IOP changes after this procedure.

Combined Phacoemulsification and Goniosynechialysis under an Endoscope for Chronic Primary Angle-Closure Glaucoma

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Li Nie

2018-01-01

Full Text Available Purpose. To investigate the clinical efficacy and safety of combined phacoemulsification with goniosynechialysis (GSL under an ophthalmic endoscope for chronic primary angle-closure glaucoma and coexisting cataract. Methods. This is a retrospective study. The intraocular pressure (IOP, best-corrected visual acuity (BCVA, and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Other measurements included supraciliochoroidal fluid measured by anterior segment optical coherence tomography, corneal endothelial cell density (ECD, and peripheral anterior synechia (PAS. All patients were followed for more than a year. Results. Thirty-eight eyes of 31 patients were included. The mean follow-up duration was 16.3 ± 3.9 months. The IOP decreased from 22.2 ± 9.3 mmHg at baseline to 15.4 ± 4.2 mmHg at the last follow-up (P<0.001. The mean number of glaucoma medications (0.1 ± 0.6 at the last follow-up was significantly lower than the preoperative number (2.3 ± 1.1 (P<0.001. All patients achieved improved or stable visual acuity after surgery. All patients achieved a complete opened angle after GSL. The postoperative complications included hyphema (7.9%, exudation (5.3%, transiently elevated IOP (55.3%, and supraciliochoroidal fluid (40%. Conclusions. Combined phacoemulsification and GSL under an endoscope can completely reopen PAS and is an effective and safe method for patients with chronic primary angle-closure glaucoma and coexisting cataract.

Corneal injection track:an unusual complication of intraocular lens implantation and review

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Julie Y.C. Lok

2015-06-01

Full Text Available Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens (IOL implantation by injection, allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines, improvement of IOL injection systems and further maturation of surgeons’ techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

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Shi-Wei Li

2015-08-01

Full Text Available AIM: To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC using ultrasound biomicroscopy (UBM.METHODS: Patients (n=23, 31 eyes were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes. Best-corrected visual acuity (BCVA, intraocular pressure (IOP, the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.RESULTS:The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05. IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05, whereas there was no significant difference between the two groups at the latter follow-up (P>0.05. Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05, whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.CONCLUSION:Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

COMPARISON OF RECENTLY USED PHACOEMULSIFICATION SYSTEMS USING A HEALTH TECHNOLOGY ASSESSMENT METHOD.

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Huang, Jiannan; Wang, Qi; Zhao, Caimin; Ying, Xiaohua; Zou, Haidong

2017-01-01

To compare the recently used phacoemulsification systems using a health technology assessment (HTA) model. A self-administered questionnaire, which included questions to gauge on the opinions of the recently used phacoemulsification systems, was distributed to the chief cataract surgeons in the departments of ophthalmology of eighteen tertiary hospitals in Shanghai, China. A series of senile cataract patients undergoing phacoemulsification surgery were enrolled in the study. The surgical results and the average costs related to their surgeries were all recorded and compared for the recently used phacoemulsification systems. The four phacoemulsification systems currently used in Shanghai are the Infiniti Vision, Centurion Vision, WhiteStar Signature, and Stellaris Vision Enhancement systems. All of the doctors confirmed that the systems they used would help cataract patients recover vision. A total of 150 cataract patients who underwent phacoemulsification surgery were enrolled in the present study. A significant difference was found among the four groups in cumulative dissipated energy, with the lowest value found in the Centurion group. No serious complications were observed and a positive trend in visual acuity was found in all four groups after cataract surgery. The highest total cost of surgery was associated with procedures conducted using the Centurion Vision system, and significant differences between systems were mainly because of the cost of the consumables used in the different surgeries. This HTA comparison of four recently used phacoemulsification systems found that each of system offers a satisfactory vision recovery outcome, but differs in surgical efficacy and costs.

Small Incision Cataract Surgery (SICS with Clear Corneal Incision and SICS with Scleral Incision – A Comparative Study

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Md Shafiqul Alam

2014-01-01

Full Text Available Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3% was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of

Alteraciones en el endotelio corneal después de la facoemulsificación por técnica de pre chop versus extracción tunelizada esclerocorneal del cristalino Alterations of the corneal endothelium after prechop phacoemulsification versus tunnelized scleracorneal extraction of the crystalline

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Belkys Rodríguez Suárez

2012-12-01

Full Text Available Objetivo: evaluar los cambios endoteliales y resultados visuales en los ojos de pacientes con diagnóstico de catarata senil, operados por técnica de facoemulsificación por pre chop o extracción extracapsular del cristalino por túnel esclerocorneal. Métodos: se realizó un estudio descriptivo y prospectivo de 100 pacientes (ojos atendidos en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", de septiembre a diciembre de 2010. La mitad fueron operados por facoemulsificación y el resto por túnel esclerocorneal. Se analizaron las variables: mejor agudeza visual corregida y sin corrección, dureza del cristalino, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo medio inducido y tiempo efectivo de ultrasonido. Resultados: la pérdida celular endotelial en el grupo de facoemulsificación fue de 9,8 % y en el de extracción tunelizada, de 6,8 %. La hexagonalidad promedio posoperatoria fue mejor en el grupo de facoemulsificación (53 %. El coeficiente de variabilidad promedio preoperatorio disminuyó de 0,32 a 0,28 en el grupo de facoemulsificación. En este grupo el astigmatismo resultante fue de 1,35 D y el tiempo efectivo de facoemulsificación estuvo por debajo de los 2 minutos. En ambos grupos la mejor agudeza visual preoperatoria sin corrección promedio fue de 0,29 y mejoró a 0,56 en la extracción por túnel esclerocorneal y a 0,8 en la facoemulsificación. Conclusiones: la facoemulsificación por pre chop, constituye una buena opción en la cirugía de catarata. Las alteraciones endoteliales que provoca son similares a las de la extracción tunelizada, con ventaja sobre esta en la visión sin cristales por la menor inducción de astigmatismo.Objective: to evaluate the endothelial changes occurred and the visual results achieved in the eyes of patients diagnosed with senile cataract, who were operated on either by the prechop phacoemulsification technique or by the extracapsular extraction of

Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema

International Nuclear Information System (INIS)

Wahab, S.; Rab, K. F. U.; Hargun, L. D.

2013-01-01

Objective: To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. Study Design: Interventional study. Place and Duration of Study: Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. Methodology: Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema (CSME), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. Results: The male to female ratio was 1:1.44. Out of 218 patients; 129 (59.2%) were males and 89 (40.8%) were females. CSME was found in 82 patients (37.6%) at first postoperative week which declined to 29 cases (13.3%) at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity (BCVA) gradually improved in each subsequent follow-up visit. Conclusion: Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed. (author)

Postoperative maintaining patients after a phacoemulsification

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S. N. Akulov

2014-07-01

Full Text Available Purpose: Studying of efficiency and safety of application of «Sistаnе-gel» after a cataract phaсoemulsification for postoperative therapy of a syndrome of a dry eye was.Methods: 56 patients (56 eyes are surveyed. 26 of them (26 eyes have primary open-angle glaucoma and receive antiglaukomе preparations in instillations. Other 30 patients didn’t use any drops. To all patients the cataract phacoemulsification is executed. After operation applied standard antibacterial and anti-inflammatory therapy and conducted complex examination, including biomicroscopy,Shirmer’s test, Norn’s test, staining the anterior surface of the eye with Fluoresceine. Besides, patients answered the questions containingin a simple questionnaire.Results: Application of the preparation «Sistane-gel» showed its high efficiency and safety in treatment of a postoperative syndrome of a dry eye after a cataract phacoemulsification.Conclusion: Taking into account specifics of patients with a cataract (advanced age, existence of the somatic diseases, the changed hormonal background, reception of medicines, all of them can recommend application of sistant-gel for prevention and dry eye treatment after phacoemulsification. Especially it is necessary to pay attention to dry eye prevention at the patients who have glaucoma and constantly using hypotensive drops.

Postoperative maintaining patients after a phacoemulsification

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S. N. Akulov

2013-01-01

Full Text Available Purpose: Studying of efficiency and safety of application of «Sistаnе-gel» after a cataract phaсoemulsification for postoperative therapy of a syndrome of a dry eye was.Methods: 56 patients (56 eyes are surveyed. 26 of them (26 eyes have primary open-angle glaucoma and receive antiglaukomе preparations in instillations. Other 30 patients didn’t use any drops. To all patients the cataract phacoemulsification is executed. After operation applied standard antibacterial and anti-inflammatory therapy and conducted complex examination, including biomicroscopy,Shirmer’s test, Norn’s test, staining the anterior surface of the eye with Fluoresceine. Besides, patients answered the questions containingin a simple questionnaire.Results: Application of the preparation «Sistane-gel» showed its high efficiency and safety in treatment of a postoperative syndrome of a dry eye after a cataract phacoemulsification.Conclusion: Taking into account specifics of patients with a cataract (advanced age, existence of the somatic diseases, the changed hormonal background, reception of medicines, all of them can recommend application of sistant-gel for prevention and dry eye treatment after phacoemulsification. Especially it is necessary to pay attention to dry eye prevention at the patients who have glaucoma and constantly using hypotensive drops.

Nocardia infection following phacoemulsification

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Gokhale Nikhil

2007-01-01

Full Text Available Infection of a self-sealing tunnel incision is a rare but vision-threatening complication of cataract surgery. We describe two cases of side port infection following an uneventful phacoemulsification. Nocardia was isolated in one case. Both the cases were worsening on medical treatment and were successfully treated by therapeutic keratoplasty.

Clinical effects of conjunctival sac flushing using different concentration of povidoneiodine on corneal epithelium before cataract surgeries

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Xue-Lian Gu

2015-10-01

Full Text Available AIM:To determine the most optimal concentration of the safe usage of povidone-iodine(PVP-Iin the flushing to disinfect the conjunctive sac before cataract surgeries, in order to provide a scientific basis for clinical eye surgery work.METHODS:Sixty-two patients with phacoemulsification and intraocular lens implantation in our hospital from October 2012 to October 2014 were randomly divided into 0.25g/L PVP-I group(Ⅰand 5g/L PVP-I group(Ⅱ. Sterilizing effect and the complications postoperative were analyzed.RESULTS:The sterilizing effects of the two groups after flushing conjunctiva sac using different concentrations of PVP-I were both remarkable, but the difference between the two groups was not statistically significant(P>0.05. No endophthalmitis occurred in the two groups. Observing the corneal condition after rinsing, no severe conjunctival hyperemia, corneal edema and other serious complications occurred. There was slightly punctate corneal epithelial shedding in groupⅡ, and the difference was statistically significant(PPCONCLUSION:Using 0.25g/L PVP-I in the conjunctiva sac rinsing before surgeries can inhibit the growth of bacteria in the conjunctival sac, reduce the impact on the corneal epithelium thereby reducing the incidence of postoperative complications and the positive rate of bacterial culture, increasing the comfort degree of patients, bringing a better area for the surgeries.

Thermal imaging comparison of Signature, Infiniti, and Stellaris phacoemulsification systems

OpenAIRE

Ryoo, NK; Kwon, J-W; Wee, WR; Miller, KM; Han, YK

2013-01-01

Abstract Background To compare the heat production of 3 different phacoemulsification machines under strict laboratory test conditions. More specifically, the thermal behavior was analyzed between the torsional modality of the Infiniti system and longitudinal modalities of the Abbot WhiteStar Signature Phacoemulsification system and Bausch and Lomb Stellaris system. Methods Experiments were performed under in-...

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems

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Chen M

2015-07-01

Full Text Available Ming Chen,1 Erik Anderson,2 Geoffrey Hill,3 John J Chen,4 Thomas Patrianakos2 1Department of Surgery, University of Hawaii, Honolulu, HI, 2Department of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, 3Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 4Biostatistics Core, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA Purpose: To compare cumulative dissipated energy between two phacoemulsification machines. Setting: An ambulatory surgical center, Honolulu, Hawaii, USA. Design: Retrospective chart review. Methods: A total of 2,077 consecutive cases of cataract extraction by phacoemulsification performed by five surgeons from November 2012 to November 2014 were included in the study; 1,021 consecutive cases were performed using the Infiniti Vision System, followed by 1,056 consecutive cases performed using the Centurion Vision System. Results: The Centurion phacoemulsification system required less energy to remove a cataractous lens with an adjusted average energy reduction of 38% (5.09 percent-seconds (P<0.001 across all surgeons in comparison to the Infiniti phacoemulsification system. The reduction in cumulative dissipated energy was statistically significant for each surgeon, with a range of 29%–45% (2.25–12.54 percent-seconds (P=0.005–<0.001. Cumulative dissipated energy for both the Infiniti and Centurion systems varied directly with patient age, increasing an average of 2.38 percent-seconds/10 years. Conclusion: The Centurion phacoemulsification system required less energy to remove a cataractous lens in comparison to the Infiniti phacoemulsification system. Keywords: phacoemulsification, cumulative dissipated energy, Centurion Vision System, Infiniti Vision System

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract

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Fakhry MA

2011-07-01

Full Text Available Mohamed A Fakhry1,2, Malak I El Shazly11Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt; 2Cataract and Refractive Consultant, International Eye Hospital, Cairo, EgyptPurpose: To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium.Settings: Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt.Methodology: Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III. Two groups were included, each having an equal number of eyes (49. The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA, intraocular pressure (IOP, slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD and central corneal thickness (CCT were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon intraocular lens (IOL. The main phaco outcome parameters included the mean ultrasound time (UST, the mean cumulative dissipated energy (CDE, and the percent of average torsional amplitude in position 3 (%TUSiP3.Results: Improvement in BCVA was statistically significant in both groups (P < 0.001. Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE. As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01. All changes of CCT, and ECD

Hydroxyl free radical production during torsional phacoemulsification.

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Aust, Steven D; Hebdon, Thomas; Humbert, Jordan; Dimalanta, Ramon

2010-12-01

To quantitate free radical generation during phacoemulsification using an ultrasonic phacoemulsification device that includes a torsional mode and evaluate tip designs specific to the torsional mode. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. Experimental study. Experiments were performed using the Infiniti Vision System and OZil handpiece. Hydroxyl radical concentrations in the aspirated irrigation solution during torsional phacoemulsification were quantitated as nanomolar malondialdehyde (nM MDA) and determined spectrophotometrically using the deoxyribose assay. The mean free radical production during phacoemulsification with torsional modality at 100% amplitude was 30.1 nM MDA ± 5.1 (SD) using a 0.9 mm 45-degree Kelman tapered ABS tip. With other tip designs intended for use with the torsional modality, free radical production was further reduced when fitted with the 0.9 mm 45-degree Kelman mini-flared ABS tip (13.2 ± 5.6 nM MDA) or the 0.9 mm 45-degree OZil-12 mini-flared ABS tip (14.3 ± 6.7 nM MDA). Although the measurements resulting from the use of the latter 2 tips were not statistically significantly different (P ≈ .25), they were different from those of the tapered tip (P<.0001). The MDA concentration in the aspirated irrigation solution using the torsional modality was approximately one half that reported for the handpiece's longitudinal modality in a previous study using the same bent-tip design (Kelman tapered, P<.0001). The level of MDA was further reduced approximately one half with torsional-specific tips. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Surgically induced astigmatism after phacoemulsification with and without correction for posture-related ocular cyclotorsion: randomized controlled study.

LENUS (Irish Health Repository)

Dooley, Ian

2012-02-01

PURPOSE: To report the impact of posture-related ocular cyclotorsion on one surgeon\\'s surgically induced astigmatism (SIA) results and the variance in SIA. SETTING: Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland. METHODS: This prospective randomized controlled study included eyes that had phacoemulsification with intraocular lens implantation. Eyes were randomly assigned to have (intervention group) or not have (control group) correction for posture-related ocular cyclotorsion. In the intervention group, the clear corneal incision was placed precisely at the 120-degree meridian with instruments designed to correct posture-related ocular cyclotorsion. In the control group, the surgeon endeavored to place the incision at the 120-degree meridian, but without markings. RESULTS: The intervention group comprised 41 eyes and the control group, 61 eyes. The mean absolute SIA was 0.74 diopters (D) in the intervention group and 0.78 D in the control group; the difference between groups was not statistically significant (P>.5, unpaired 2-tailed Student t test). The variance in SIA was 0.29 D(2) and 0.31 D(2), respectively; the difference between groups was not statistically significant (P>.5, unpaired F test). CONCLUSIONS: Attempts to correct for posture-related ocular cyclotorsion did not influence SIA or its variance in a single-surgeon series. These results should be interpreted with full appreciation of the limitations of currently available techniques to correct for posture-related ocular cyclotorsion in the clinical setting.

Turning the tide of corneal blindness

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Matthew S Oliva

2012-01-01

Full Text Available Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world′s largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

Comparison of torsional and longitudinal modes using phacoemulsification parameters.

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Rekas, Marek; Montés-Micó, Robert; Krix-Jachym, Karolina; Kluś, Adam; Stankiewicz, Andrzej; Ferrer-Blasco, Teresa

2009-10-01

To compare phacoemulsification parameters of torsional and longitudinal ultrasound modes. Ophthalmology Department, Military Health Service Institute, Warsaw, Poland. This prospective study evaluated eyes 1, 7, and 30 days after phacoemulsification with an Infiniti Vision System using the torsional or longitudinal ultrasound (US) mode. Cataract classification was according to the Lens Opacities Classification System II. Nucleus fragmentation was by the phaco-chop and quick-chop methods. Primary outcome measures were phaco time, mean phaco power, mean torsional amplitude, and aspiration time. Total energy, defined as cumulative dissipated energy (CDE) x aspiration time, and the effective coefficient, defined as aspiration time/phaco time, were also calculated. Four hundred eyes were evaluated. The CDE was statistically significantly lower in the torsional mode for nucleus grades I, II, and III (P.05). Aspiration time was statistically significantly shorter in the torsional mode than in the longitudinal mode for nucleus grades III and IV (P<.05). Total energy was significantly lower in the torsional mode for all nucleus densities (P<.05). The effective coefficient was significantly lower in the longitudinal mode except for nucleus grade I (P<.05). Torsional phacoemulsification was more effective than longitudinal phacoemulsification in the amount of applied fluid and the quantity of US energy expended. With the torsional method, it was possible to maintain a constant ratio of amount of fluid flow to quantity of US energy used, regardless of nucleus density.

Clinical observation of phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy

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Jun-Yong Wang

2014-10-01

Full Text Available AIM: To observe the effect of phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy.METHODS: Phacoemulsification combined goniosynechialysis was performed on 16 patients(16 eyeswith absolute glaucoma after trabeculectomy, and they were followed up for 6～12mo, The postoperative intraocular pressure(IOPand anterior chamber depth, preoperative and postoperative medication types(quantity, preoperative and postoperative 1 month's status of anxiety and depression, symptoms of ocular surface were observed.RESULTS: The IOP decreased significantly after phacoemulsification combined goniosynechialysis. The mean IOP was 35.00±15.43mmHg preoperatively, and it was 12.00±6.69mmHg, 15.00±4.26mmHg and 15.3±5.2mmHg on 1d, 6 and 12mo after the surgery. The statistic difference was found between preoperative and postoperative(t=6.22, Pt=6.65, PCONCLUSION: Phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy is a safe and effective surgical option.

The Auckland Cataract Study: 2 year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes

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Thompson, A M; Sachdev, N; Wong, T; Riley, A F; Grupcheva, C N; McGhee, C N

2004-01-01

Aim: To assess clinical, visual, computerised corneal topographic, and subjective satisfaction with visual acuity, in a cohort of subjects 2 years after phacoemulsification surgery in a public hospital in New Zealand. Methods: Prospective study of a representative sample of 97 subjects (20%) randomly selected from 480 subjects in the original Auckland Cataract Study (ACS) cohort. The clinical assessment protocol was identical to the ACS and included an extensive questionnaire to enable direct comparisons to be made between the two groups. Results: The study population was predominantly female (66%) with a mean age of 76.3 (SD 9.9) years. New systemic and ocular disease affected 18.4% and 10.3% of subjects respectively, and 10.3% required referral to either a general practitioner (2.1%) or ophthalmologist (8.2%). Mean best spectacle corrected visual acuity (BSCVA) was 0.2 (0.2) logMAR units (6/9 Snellen equivalent), with mean spherical equivalent −0.37 (1.01) dioptres (D) and astigmatism −1.07 (0.70) D 2 years postoperatively, compared to mean BSCVA 0.1 (0.2) logMAR units (6/7.5 Snellen equivalent), spherical equivalent −0.59 (1.07) D, and astigmatism −1.14 (0.77) D 4 weeks after surgery. 94.9% of subjects retained a BSCVA of 6/12 or better, irrespective of pre-existing ocular disease. The overall posterior capsule opacification (PCO) rate was 20.4% and this was visually insignificant in all but 3.1% of eyes that had already undergone Nd:YAG posterior capsulotomy. Orbscan II elevation technology demonstrated corneal stability 2 years after uncomplicated phacoemulsification. Although corneal astigmatism was eliminated in approximately half of the subjects 1 month postoperatively, astigmatism showed a tendency to regress towards the preoperative level with local corneal thickening at the site of incision 2 years after cataract surgery. Of fellow eyes, 61.2% had undergone cataract surgery. Overall, 75.3% of subjects were moderately to very satisfied with their

Punctiform and Polychromatophilic Dominant Pre-Descemet Corneal Dystrophy.

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Lagrou, Lisa; Midgley, Julian; Romanchuk, Kenneth Gerald

2016-04-01

To describe the slit-lamp appearance and corneal confocal microscopy of autosomal dominant punctiform and polychromatophilic pre-Descemet corneal dystrophy in 3 members of the same family. Slit-lamp examination of a 9-year-old boy showed bilateral polychromatophilic corneal opacities in a pre-Descemet membrane location evenly deposited limbus to limbus, both horizontally and vertically, with an intervening clear cornea. The corneal endothelium was normal on corneal confocal microscopy, with hyperreflective opacities of various sizes located pre-Descemet membrane. Slit-lamp examination of the patient's father and brother revealed identical crystalline deposition in the pre-Descemet corneal stroma. The remainders of the eye examinations were otherwise normal in all 3 individuals, and all were asymptomatic. The general physical examination and laboratory investigations of the patient were all normal, as were the laboratory investigations of the other 2 family members. There was no progression in the corneal findings over 6 months of follow-up. These patients likely illustrate a rare autosomal dominant pre-Descemet crystalline keratopathy that has been reported only once previously.

Relationship between lens density measurements by Pentacam Scheimpflug imaging and torsional phacoemulsification parameters

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Suleyman Demircan

2014-10-01

Full Text Available AIM: To evaluate the relationship between the density values of the lens nucleus measured using Pentacam Scheimpflug imaging and torsional phacoemulsification dynamics such as the level of ultrasound energy, as well as the duration and amount of fluid used in patients with age-related nuclear cataract. METHODS: This was a prospective observer-masked study. Pentacam Scheimpflug imaging was performed following pupil dilation. The cataracts were automatically graded from 1 to 5 using pentacam nucleus densitometry(PND, also known as Pentacam nucleus staging(PNSsoftware by the same observer. After phacoemulsification, total Ultrasound(U/Stime, Cumulative dissipated energy(CDE, Torsional U/S time, and Estimated fluid use were automatically calculated and displayed on the monitor of Infiniti OZiL IP phacoemulsification system. One-way analysis of variance(ANOVAwas used to assess differences between groups. The Tamhane test was used for multiple group analysis. Spearman correlation analysis was used to assess the relationship between lens density measured by PND and the dynamics of torsional phacoemulsification. P0.05 was considered statistically significant. RESULTS:In the present study, 125 eyes from 125 patients were evaluated. Mean age was 69.7±9.4y(range: 48-88y, and 61 men and 64 women were included. The highest and lowest values of U/S total time, torsional U/S time, CDE, and Estimated fluid use were 0.70 - 158.90s, 0.70-158.50s, 0.11-42.65, and 21-98 mL in groups, respectively. Significant differences were found among PND groups. When the relationship between phacoemulsification dynamics and PND values were evaluated, there were significant correlations between PND value and total ultrasound time(r=0.767; Pr=0.767; Pr=0.758; Pr=0.602; PCONCLUSION:An objective degree of nucleus density obtained by PND scoring before cataract surgery may allow antecedent determination of intraoperative phacoemulsification parameters. Thus, individualized

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes

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Rakesh Maggon

2017-01-01

Full Text Available Purpose: To compare Endothelial cell(EC loss following Phacoemulsification (PKE in pupils of different sizes. Methods: A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size 7 mm. Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. Results: The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. Conclusion: PKE done in eyes with maximal pupillary dilatation of 5 mm at the end of one month.

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes.

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Maggon, Rakesh; Bhattacharjee, Raghudev; Shankar, Sandeep; Kar, Rajesh Chandra; Sharma, Vivek; Roy, Shyamal

2017-12-01

To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size 7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. PKE done in eyes with maximal pupillary dilatation of 5 mm at the end of one month.

Vessel cauterization as a therapeutic adjunct in persistent disciform corneal stromal edema

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Lasisi Akinola Muideen

2014-01-01

Full Text Available This is a case report of a symptomatic non-clearing, vascularized, disciform, corneal stromal edema with a feeder vessel that has remained refractory to medical therapy of antiviral, steroid, and antibiotics, for a period of three weeks, but showed a rapid improvement in visual acuity of 0.1 Log mar within five days of feeder vessel cauterization, together with improvement of two psychometric scales in corneal cloudiness on a scale range of 0 to 3, clinical evidence of resolution of corneal edema, and subjective resolution of the patient′s symptoms. Cauterization was done under magnification with a ball cautery point warmed in a spirit lamp following topical anesthesia. This intervention may become handy in difficult non-clearing corneal edema and prevent blinding consequences, in a low-resource facility, in selected applicable cases.

Phacoemulsification and implantation of an accommodating IOL after PRK.

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Aslanides, loannis M; Plainis, Sotiris; Kumar, Vinod; Ginis, Harilaos

2006-01-01

To present a case of phacoemulsification and implantation of an accommodating intraocular lens (IOL) in a patient with cataract formation after previous refractive surgery. A 50-year-old man, who initially had photorefractive keratectomy to correct moderate myopia, developed a cataract in one eye. He subsequently underwent phacoemulsification and implantation of a 1CU accommodating IOL, as he wished to remain spectacle independent. The patient's distance vision was fully restored. However, accommodative function, which was assessed using subjective and novice objective techniques, was only partially restored. Although the accommodating IOL fully restored the patient's distance vision, accommodative function was only partially restored.

Evaluation of Corneal Neovascularization Using Optical Coherence Tomography Angiography in Patients With Limbal Stem Cell Deficiency.

Science.gov (United States)

Oie, Yoshinori; Nishida, Kohji

2017-11-01

Detection of the exact area of corneal neovascularization using slit-lamp photography is often difficult. Thus, we evaluated corneal neovascularization in patients with limbal stem cell deficiency using optical coherence tomography angiography (OCTA). Five patients with 5 eyes showing partial or total limbal stem cell deficiency were enrolled. Three eyes had severe corneal scarring. Five 6- × 6-mm images (frontal, upper, lower, nasal, and temporal) were obtained by OCTA. Slit-lamp photography was performed for all patients on the same day. OCTA has 2 advantages over slit-lamp photography for clear demonstration of corneal neovascularization. First, OCTA can show neovascularization in cases with severe corneal opacification. Second, OCTA can detect not only large vessels but also small vessels that cannot be seen by slit-lamp photography. OCTA is a powerful tool for objective evaluation of vascularization in the anterior and posterior segments of the eye. We have demonstrated that OCTA can visualize corneal neovascularization in patients with corneal diseases more clearly than slit-lamp photography.

The analysis of clinical effect of phacoemulsification on primary angle-closure glaucoma with cataract

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Ling Zhao

2013-07-01

Full Text Available AIM:To evaluate the clinical outcomes and affected factors of prognosis of cataract extraction by phacoemulsification with intraocular lens implantation in eyes with primary angle-closure glaucoma(PACGand co-existing cataract.METHODS: Totally 60 cases(70 eyesof PACG with cataract, including 43 eyes with acute primary angle-closure glaucoma(APACG, 27 eyes of chronic primary angle-closure glaucoma(CPACG. The main outcome measures included: visual acuity, intraocular pressure, gonioscopy, depth of anterior chamber(ACD. Patients were examined 6 months after surgery.RESULTS: After phacoemulsification, visual acuity was improved(PPPPCONCLUSION:Phacoemulsification is more effective for acute APACG than for CPACG.

Asteroid hyalosis removal during phacoemulsification: an anterior approach

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Mohamed Anbar

2017-01-01

Removal of AH by means of anterior vitrectomy during phacoemulsification through a posterior capsulorhexis is safe and effective and enables the surgeon to treat undiagnosed missed retinal lesions that were not obvious preoperatively.

Effect of Anterior Chamber Depth on Intraocular Pressure after Uneventful Phacoemulsification Surgery in Nonglaucomatous Eyes with CataractEffect of Anterior Chamber Depth on Intraocular Pressure after Uneventful Phacoemulsification Surgery in Nonglaucomatous Eyes with CataractEffect of Anterior Chamber Depth on Intraocular Pressure after Uneventful Phacoemulsification Surgery in Nonglaucomatous Eyes with Cataract

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Tansu Gönen

2011-08-01

Full Text Available Purpose: To evaluate the effect of preoperative anterior chamber depth (ACD on intraocular pressure (IOP after uneventful phacoemulsification and intraocular lens (IOL implantation in nonglaucomatous eyes. Material and Method: The medical records of fifty-five patients (30 male and 25 female were reviewed retrospectively. The patients who had undergone uneventful phacoemulsification and IOL implantation were divided into two groups according to the values of preoperative ACD: 30 eyes in group 1 (ACD≤3.27 mm and 25 eyes in group 2 (ACD>3.27 mm. IOP was measured using non-contact tonometer preoperatively and postoperatively (1 day, 1 week, 1 month, and 3 months. Results: Three months after phacoemulsification and IOL implantation, the mean IOP decreased 23.6% in group 1 and 13.7% in group 2. There was a statistically significant difference between the groups (p= 0.025. Discussion: The mean IOP decreases in eyes with shallow anterior chamber more than in normal eyes after uncomplicated phacoemulsification and IOL implantation. (Turk J Ophthalmol 2011; 41: 207-12

Phacoemulsification in subluxated cataract.

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Praveen M

2003-01-01

Full Text Available Purpose: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. Materials and Methods: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA, slitlamp examination, presence of vitreous in anterior chamber, extent of subluxation, intraocular pressure (IOP and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA, IOP, pupillary reaction and the IOL position. Results: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 ± 9.71 months (range 4-39. The average age was 39.15 ± 16.33 (range 5 - 74. A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%. Capsule tension ring (CTR was implanted in 15 eyes (68.18%. Twelve eyes (54.5% had in-the-bag implants, while 5 (22.72% had scleral fixation. The remaining 5 eyes (22.72% had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5% had clinically and geometrically well centered IOLs while 9 eyes (40.9% had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55% had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40% had BCVA of 6/18. The remaining 4 eyes (14.81% had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%, pupillary capture of the IOL optic in 2 eyes (9.09%; the same 2 eyes (9.09% required redialing of IOL. One eye (4.54% had to undergo refixation (one haptic was fixed to sclera year after cataract

Corneal Laceration

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Full Text Available ... Eye Health A-Z Symptoms Glasses & Contacts Tips & Prevention News Ask an Ophthalmologist Patient Stories Español Eye ... Causes Corneal Laceration? Corneal Laceration Diagnosis Corneal Laceration Treatment What Is Corneal Laceration? Leer en Español: ¿Qué ...

Spontaneous Corneal Hydrops in a Patient with a Corneal Ulcer

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Hatim Batawi

2016-01-01

Full Text Available Purpose: We report the case of a 77-year-old man with no history of keratoconus or other ectatic disorders who presented with corneal hydrops in the setting of a corneal ulcer. The risk factors, pathogenesis and treatment options of corneal hydrops are discussed. Method: This is an observational case report study. Results: A 77-year-old man presented with a 1-day history of severe pain, redness, mucous discharge and photophobia in the right eye. A slit-lamp examination of the right eye showed an area of focal corneal edema and protrusion. Within the area of edema and protrusion, there was an infiltrate with an overlying epithelial defect consistent with an infectious corneal ulcer. The Seidel test showed no leakage, so a clinical diagnosis of corneal hydrops associated with nonperforated corneal ulcer was made. With appropriate antibiotic treatment, the corneal ulcer and hydrops both resolved over a 1-month period. Conclusion: Corneal hydrops can occur in the setting of corneal infections.

Using corneal topography design personalized cataract surgery programs

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Jin-Ou Huang

2014-08-01

Full Text Available AIM:To investigate how to design personalized cataract surgery programs to achieve surgical correction of preoperative corneal astigmatism with surgical astigmatism under the guidance of corneal topography, improve postoperative visual quality and reduce the cost of treatment. METHODS: Totally 202 cases(226 eyescataract patients were divided into randomized treatment group and individualized treatment group. According to the method and location of the incision, randomized treatment group were divided into 8 groups. Surgical astigmatism after different incision were calculated with the use of preoperative and postoperative corneal astigmatism through vector analysis method. Individualized treatment groups were designed personably for surgical method with reference of every surgically induced astigmatism, the surgical method chooses the type of surgical incision based on close link between preoperative corneal astigmatism and surgically induced astigmatism, and the incision was located in the steep meridian. The postoperative corneal astigmatism of individualized treatment group was observed. RESULTS: Postoperative corneal astigmatism of individualized treatment group were lower than that of 3.0mm clear corneal tunnel incision in the randomized treatment group, there were statistically significance difference, while with 3.0mm sclera tunnel incision group there were no statistically significance difference. After 55.8% of patients with the use of individualized surgical plan could undergo the operation of extracapsular cataract extraction with relatively low cost and rigid intraocular lens implantation, the per capita cost of treatment could be reduced. CONCLUSION: Personalized cataract surgery programs are designed to achieve surgical correction of preoperative corneal astigmatism under the use of corneal topography, improve postoperative visual quality and reduce the cost of treatment.

Corneal biomechanical properties from air-puff corneal deformation imaging

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Marcos, Susana; Kling, Sabine; Bekesi, Nandor; Dorronsoro, Carlos

2014-02-01

The combination of air-puff systems with real-time corneal imaging (i.e. Optical Coherence Tomography (OCT), or Scheimpflug) is a promising approach to assess the dynamic biomechanical properties of the corneal tissue in vivo. In this study we present an experimental system which, together with finite element modeling, allows measurements of corneal biomechanical properties from corneal deformation imaging, both ex vivo and in vivo. A spectral OCT instrument combined with an air puff from a non-contact tonometer in a non-collinear configuration was used to image the corneal deformation over full corneal cross-sections, as well as to obtain high speed measurements of the temporal deformation of the corneal apex. Quantitative analysis allows direct extraction of several deformation parameters, such as apex indentation across time, maximal indentation depth, temporal symmetry and peak distance at maximal deformation. The potential of the technique is demonstrated and compared to air-puff imaging with Scheimpflug. Measurements ex vivo were performed on 14 freshly enucleated porcine eyes and five human donor eyes. Measurements in vivo were performed on nine human eyes. Corneal deformation was studied as a function of Intraocular Pressure (IOP, 15-45 mmHg), dehydration, changes in corneal rigidity (produced by UV corneal cross-linking, CXL), and different boundary conditions (sclera, ocular muscles). Geometrical deformation parameters were used as input for inverse finite element simulation to retrieve the corneal dynamic elastic and viscoelastic parameters. Temporal and spatial deformation profiles were very sensitive to the IOP. CXL produced a significant reduction of the cornea indentation (1.41x), and a change in the temporal symmetry of the corneal deformation profile (1.65x), indicating a change in the viscoelastic properties with treatment. Combining air-puff with dynamic imaging and finite element modeling allows characterizing the corneal biomechanics in-vivo.

The Influence of Phacoemulsification on Surgical Outcomes of Trabeculectomy with Mitomycin-C for Uveitic Glaucoma.

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Asaho Nishizawa

Full Text Available To evaluate the influence of phacoemulsification after trabeculectomy on the postoperative intraocular pressure (IOP in eyes with uveitic glaucoma (UG.Kumamoto University Hospital, Kumamoto, Japan.A retrospective cohort study.The medical records of patients with UG who had trabeculectomy with mitomycin-C (MMC were reviewed. Complete and qualified surgical failures were defined by an IOP of ≥21 mmHg (condition A, ≥18 mmHg (condition B, or ≥15 mmHg (condition C without and with glaucoma eye drops, respectively. Kaplan-Meier survival analysis, generalized by the Wilcoxon test, and the Cox proportional hazards model analysis were conducted. Post-trabeculectomy phacoemulsification was treated as a time-dependent variable. In 24 (30% of the included 80 eyes, phacoemulsification was included, and they were divided into two groups: groups I (8 eyes with phacoemulsification within 1 year after trabeculectomy and group II (16 eyes after 1 year following trabeculectomy.Multivariable Cox proportional hazards model analysis showed post-trabeculectomy phacoemulsification was a significant factor in both complete success and qualified success based upon condition C (P = 0.0432 and P = 0.0488, respectively, but not for the other conditions. Kaplan-Meier survival analyses indicated significant differences in success probabilities between groups I and group II for complete success and qualified success based upon condition C (P = 0.020 and P = 0.013, respectively. There was also a significant difference for qualified success based upon condition B (P = 0.034, while there was no significant difference for the other conditions.Post-trabeculectomy phacoemulsification, especially within 1 year, can cause poor prognosis of IOP control of UG eyes after trabeculectomy with MMC.

Corneal Laceration

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Full Text Available ... Ophthalmology/Strabismus Ocular Pathology/Oncology Oculoplastics/Orbit Refractive ... Corneal Laceration Sections What Is Corneal Laceration? Corneal Laceration Symptoms What Causes ...

Scheimpflug camera combined with placido-disk corneal topography and optical biometry for intraocular lens power calculation.

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Kirgiz, Ahmet; Atalay, Kurşat; Kaldirim, Havva; Cabuk, Kubra Serefoglu; Akdemir, Mehmet Orcun; Taskapili, Muhittin

2017-08-01

The purpose of this study was to compare the keratometry (K) values obtained by the Scheimpflug camera combined with placido-disk corneal topography (Sirius) and optical biometry (Lenstar) for intraocular lens (IOL) power calculation before the cataract surgery, and to evaluate the accuracy of postoperative refraction. 50 eyes of 40 patients were scheduled to have phacoemulsification with the implantation of a posterior chamber intraocular lens. The IOL power was calculated using the SRK/T formula with Lenstar K and K readings from Sirius. Simulated K (SimK), K at 3-, 5-, and 7-mm zones from Sirius were compared with Lenstar K readings. The accuracy of these parameters was determined by calculating the mean absolute error (MAE). The mean Lenstar K value was 44.05 diopters (D) ±1.93 (SD) and SimK, K at 3-, 5-, and 7-mm zones were 43.85 ± 1.91, 43.88 ± 1.9, 43.84 ± 1.9, 43.66 ± 1.85 D, respectively. There was no statistically significant difference between the K readings (P = 0.901). When Lenstar was used for the corneal power measurements, MAE was 0.42 ± 0.33 D, but when simK of Sirius was used, it was 0.37 ± 0.32 D (the lowest MAE (0.36 ± 0.32 D) was achieved as a result of 5 mm K measurement), but it was not statistically significant (P = 0.892). Of all the K readings of Sirius and Lenstar, Sirius 5-mm zone K readings were the best in predicting a more precise IOL power. The corneal power measurements with the Scheimpflug camera combined with placido-disk corneal topography can be safely used for IOL power calculation.

Dry Eye Following Phacoemulsification Surgery and its Relation to Associated Intraoperative Risk Factors.

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Sahu, P K; Das, G K; Malik, Aman; Biakthangi, Laura

2015-01-01

The purpose was to study dry eye following phacoemulsification surgery and analyze its relation to associated intra-operative risk factors. A prospective observational study was carried out on 100 eyes of 100 patients without preoperative dry eye. Schirmer's Test I, tear meniscus height, tear break-up time, and lissamine green staining of cornea and conjunctiva were performed preoperatively and at 5 days, 10 days, 1-month, and 2 months after phacoemulsification surgery, along with the assessment of subjective symptoms, using the dry eye questionnaire. The correlations between these values and the operating microscope light exposure time along with the cumulative dissipated energy (CDE) were investigated. There was a significant deterioration of all dry eye test values following phacoemulsification surgery along with an increase in subjective symptoms. These values started improving after 1-month postoperatively, but preoperative levels were not achieved till 2 months after surgery. Correlations of dry eye test values were noted with the operating microscope light exposure time and CDE, but they were not significant. Phacoemulsification surgery is capable of inducing dry eye, and patients should be informed accordingly prior to surgery. The clinician should also be cognizant that increased CDE can induce dry eyes even in eyes that were healthy preoperatively. In addition, intraoperative exposure to the microscopic light should be minimized.

Comparison of corneal power obtained from VERION image-guided surgery system and four other devices

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Lin HY

2017-07-01

� to 65.17°, respectively.Conclusion: None of the VERION parameters were significantly different from those of AL-Scan and LenStar. AL-Scan (2.4 mm zone was especially similar to VERION. Wide LOAs are potential contributors to axis error in patients with toric IOL implants. Keywords: phacoemulsification, toric IOL, corneal astigmatism, surgical induced astigmatism, image-guided surgery system

Role of corneal collagen fibrils in corneal disorders and related pathological conditions

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Hong-Yan Zhou

2017-05-01

Full Text Available The cornea is a soft tissue located at the front of the eye with the principal function of transmitting and refracting light rays to precisely sense visual information. Corneal shape, refraction, and stromal stiffness are to a large part determined by corneal fibrils, the arrangements of which define the corneal cells and their functional behaviour. However, the modality and alignment of native corneal collagen lamellae are altered in various corneal pathological states such as infection, injury, keratoconus, corneal scar formation, and keratoprosthesis. Furthermore, corneal recuperation after corneal pathological change is dependent on the balance of corneal collagen degradation and contraction. A thorough understanding of the characteristics of corneal collagen is thus necessary to develop viable therapies using the outcome of strategies using engineered corneas. In this review, we discuss the composition and distribution of corneal collagens as well as their degradation and contraction, and address the current status of corneal tissue engineering and the progress of corneal cross-linking.

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems.

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Sharif-Kashani, Pooria; Fanney, Douglas; Injev, Val

2014-07-30

Occlusion break surge during phacoemulsification cataract surgery can lead to potential surgical complications. The purpose of this study was to quantify occlusion break surge and vacuum rise time of current phacoemulsification systems used in cataract surgery. Occlusion break surge at vacuum pressures between 200 and 600 mmHg was assessed with the Infiniti® Vision System, the WhiteStar Signature® Phacoemulsification System, and the Centurion® Vision System using gravity-fed fluidics. Centurion Active FluidicsTM were also tested at multiple intraoperative pressure target settings. Vacuum rise time was evaluated for Infiniti, WhiteStar Signature, Centurion, and Stellaris® Vision Enhancement systems. Rise time to vacuum limits of 400 and 600 mmHg was assessed at flow rates of 30 and 60 cc/minute. Occlusion break surge was analyzed by 2-way analysis of variance. The Centurion system exhibited substantially less occlusion break surge than the other systems tested. Surge area with Centurion Active Fluidics was similar to gravity fluidics at an equivalent bottle height. At all Centurion Active Fluidics intraoperative pressure target settings tested, surge was smaller than with Infiniti and WhiteStar Signature. Infiniti had the fastest vacuum rise time and Stellaris had the slowest. No system tested reached the 600-mmHg vacuum limit. In this laboratory study, Centurion had the least occlusion break surge and similar vacuum rise times compared with the other systems tested. Reducing occlusion break surge may increase safety of phacoemulsification cataract surgery.

Microcoaxial cataract surgery outcomes: comparison of 1.8 mm system and 2.2 mm system.

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Lee, Kyung-Min; Kwon, Hyung-Goo; Joo, Choun-Ki

2009-05-01

To compare clinical outcomes of a 1.8 mm and a 2.2 mm microcoaxial cataract surgery system. Department of Ophthalmology and Visual Science, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. In a prospective study, eyes were randomly selected to have phacoemulsification using a Stellaris system or an Intrepid Infiniti system. The initial incision size was 1.8 mm and 2.2 mm, respectively. Measured intraoperative parameters included phacoemulsification time, mean cumulative dissipated ultrasound energy (CDE), change in incision size at each step of surgery, and total volume of balanced salt solution (BSS) used. The best corrected visual acuity (BCVA), corneal astigmatism, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. The study evaluated 86 eyes of 78 patients (43 eyes in each group). There were no significant differences in postoperative BCVA, surgically induced astigmatism, or amount of BSS used between the 2 systems (P >.05). However, for high-density cataracts, the 1.8 mm group had a greater change between the initial incision size and the incision size after phacoemulsification (P = .019, nuclear opalescence [NO] NO3; P = .001, NO4), a longer phacoemulsification time (P = .013, NO3), greater mean CDE (P = .005, NO3; P = .001, NO4), and greater corneal endothelial cell loss (P = .003, NO4). Both systems were safe and effective in microcoaxial phacoemulsification. The 1.8 mm system performed better with cortical-type cataract and the 2.2 mm system, with high-density nuclear-type cataract.

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents.

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Ng, Danny Siu-Chun; Sun, Zihan; Young, Alvin Lerrmann; Ko, Simon Tak-Chuen; Lok, Jerry Ka-Hing; Lai, Timothy Yuk-Yau; Sikder, Shameema; Tham, Clement C

2018-01-01

To identify residents' perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann-Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor's intervention, and 3) prior simulation training. The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks. Residents who had completed Eyesi simulation training had higher

Clinical observation of capsular tension ring implantation in congenital lens subluxation treating by phacoemulsification

OpenAIRE

Liang-Nan Sun; Bai-Jun Li; Yuan-Fei Zhu; Xin-Hua Liu

2017-01-01

AIM: To evaluate the clinical results of capsular tension ring(CTR)implantation in phacoemulsification for eyes with congenital lens subluxation. METHODS: This study comprised 18 patients(31 eyes)with congenital ectopia lentis. All patients received phacoemulsification with CTR and intraocular lens(IOL)implantation. Visual acuity before and after surgery were examined. IOL decentration were measured with Image-Pro Plus image processing software. The complications were also recorded preoperati...

DEPLOYMENT OF SIX SIGMA METHODOLOGY IN PHACOEMULSIFICATION CATARACT SURGERY

Directory of Open Access Journals (Sweden)

Ibrahim SAHBAZ

2014-04-01

Full Text Available The purpose of this study is to show how a public eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after phacoemulsification cataract surgeries. To analyze the 3-year data, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Experience of the ophthalmic surgeon, patient’s anatomy, cooperation of patient during the surgery, sterilization and hygiene, attention of assistant surgeon, calibration of equipment and quality/chemical composition of intraocular material were identified to be Critical-to-Quality (CTQ factors for a successful phacoemulsification cataract surgery. The most frequently occurring complication was found to be iris atrophy. The process sigma level for the process was found to be 3.958.

Improvement of chronic corneal opacity in ocular surface disease with prosthetic replacement of the ocular surface ecosystem (PROSE) treatment.

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Cressey, Anna; Jacobs, Deborah S; Remington, Crystal; Carrasquillo, Karen G

2018-06-01

To demonstrate clearing of chronic corneal opacities and improvement of visual acuity with the use of BostonSight prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in ocular surface disease. We undertook retrospective analysis of the medical records of a series of patients who underwent PROSE treatment from August 2006 to December 2014. Patients were referred for ocular surface disease of various etiologies. Primary inclusion criterion was corneal opacity that improved with PROSE treatment. Patients were excluded if topical steroids or adjuvant therapy used once PROSE treatment was initiated. Underlying disease, prior treatment, clinical presentation, and clinical course were extracted from the medical record. Four patients are included in this series. There were three females and one male; median age at time of treatment initiation was 30 years (range = 0.5-58 years). Median duration of PROSE treatment at time of retrospective analysis was 3.5 years (range = 1-8 years). Two cases had corneal opacification in the context of neurotrophic keratopathy: a unilateral case due to presumed herpes simplex keratitis and a bilateral case due to congenital corneal anesthesia associated with familial dysautonomia. One case had corneal opacity from exposure related to seventh nerve palsy, and one had corneal opacification associated with recurrent surface breakdown, neurotrophic keratopathy, and limbal stem deficiency of uncertain etiology. After consistent wear of prosthetic devices used in PROSE treatment for support of the ocular surface, visual acuity improved and clearing of the opacities was observed, without use of topical steroids or adjuvant therapy. These cases demonstrate clearing of chronic corneal opacity with PROSE treatment for ocular surface disease. This clearing can occur with no adjuvant therapy, suggesting that restoration of ocular surface function and integrity allows for corneal remodeling.

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification.

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Reuschel, Anna; Bogatsch, Holger; Barth, Thomas; Wiedemann, Renate

2010-11-01

To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Department of Ophthalmology, University of Leipzig, Germany. Randomized single-center clinical trial. Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Corneal densitometry and its correlation with age, pachymetry, corneal curvature, and refraction.

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Garzón, Nuria; Poyales, Francisco; Illarramendi, Igor; Mendicute, Javier; Jáñez, Óscar; Caro, Pedro; López, Alfredo; Argüeso, Francisco

2017-12-01

To determine normative corneal densitometry values in relation to age, sex, refractive error, corneal thickness, and keratometry, measured using the Oculus Pentacam system. Three hundred and thirty-eight healthy subjects (185 men; 153 women) with no corneal disease underwent an exhaustive ocular examination. Corneal densitometry was expressed in standardized grayscale units (GSU). The mean corneal densitometry over the total area was 16.46 ± 1.85 GSU. The Pearson correlation coefficient for total densitometry was r = 0.542 (p  0.05). This is the first report of normative corneal densitometry values in relation to keratometry, corneal thickness, and spherical equivalent measured with the latest Oculus Pentacam software. Corneal densitometry increases with age, but corneal keratometry and refractive parameters do not affect light scattering in the human cornea.

Phacoemulsification of bilateral cataracts in two pet rabbits | Gomes ...

African Journals Online (AJOL)

Two 3 year-old, healthy, client-owned Lop rabbits presented with bilateral cataracts. After performing a physical examination, bloodwork, ocular ultrasonography and electroretinography, both animals were deemed good surgical candidates for phacoemulsification. Bilateral cataract surgery was performed and both rabbits ...

Progress of research on corneal collagen cross-linking for corneal melting

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Ke-Ren Xiao

2016-06-01

Full Text Available Corneal collagen cross-linking(CXLcould increase the mechanical strength, biological stability and halt ectasia progression due to covalent bond formed by photochemical reaction between ultraviolet-A and emulsion of riboflavin between collagen fibers in corneal stroma. Corneal melting is an autoimmune related noninfectious corneal ulcer. The mechanism of corneal melting, major treatment, the basic fundamental of ultraviolet-A riboflavin induced CXL and the clinical researches status and experiment in CXL were summarized in the study.

[Results of combined endotrabeculectomy and phacoemulsification surgery].

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Novytskyy, I Ya; Novytskyy, M I

2015-01-01

to identify indications and evaluate the efficacy of combined endotrabeculectomy and phacoemulsification surgery. A total of 172 patients (193 eyes) with open-angle glaucoma and cataract were enrolled. Group 1 included 102 patients (118 eyes), who were considered surgical candidates due to decompensation of IOP, group 2--70 patients (75 eyes), in whom IOP control could only be achieved with a multidrug regimen (two or more ocular hypotensive medications). The mean preoperative IOP measured with Maklakov tonometer was 26.4 ± 1.8 mmHg in group 1 and 20.5 ± 1.7 mmHg in group 2. In 134 eyes the extent of retention of intraocular fluid was determined intraoperatively by provoking blood reflux into Schlemm's canal. In 6 out of 134 eyes (4.5%) Schlemm's canal was not at all filled with blood, which was considered a contraindication for endotrabeculectomy. Partial filling of Schlemm's canal with blood was observed in 26 out of 134 eyes (19.4%), complete--in 102 eyes (76.1%). All but 6 patients underwent endotrabeculectomy (ab interno trabecular excision with original forceps through the anterior chamber angle) combined with cataract phacoemulsification and intraocular lens implantation. In 11 out of 126 cases, insignificant bleeding occurred during sample acquisition. No other complications were registered. Six months after the surgery, IOP was reduced by the mean of 7.0 ± 0.6 mmHg (26.5% from the baseline) in group 1 and by 2.2 ± 0.2 mmHg (10.7% from the baseline) in group 2. The number of hypotensive medications by that time has been decreased from 2.3 ± 0.3 to 0.8 ± 0.2 in group 1 and from 1.6 ± 0.3 to 0.4 ± 0.1 in group 2. Combined endotrabeculectomy and phacoemulsification surgery is a pathogenically oriented procedure, which improves ocular hydrodynamics and has a significant hypotensive effect.

Bent versus straight tips in micropulsed longitudinal phacoemulsification.

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Stagg, Brian C; Gupta, Isha; Cahoon, Judd; Ronquillo, Cecinio; Shi, Dallas; Zaugg, Brian; Gardiner, Gareth; Barlow, William R; Pettey, Jeff H; Aabid Farukhi, M; Jensen, Jason; Olson, Randall J

2015-10-01

The aim of this study was to evaluate bent and straight phacoemulsification tips to determine which tip is more efficient in removal of lens fragments, using micropulsed longitudinal ultrasound in phacoemulsification. In vitro laboratory study. The John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Pig lenses hardened in a manner comparable with dense human cataracts were cut into 2-mm cubes and removed with micropulsed longitudinal ultrasound using settings previously shown to be optimally efficient (6 milliseconds on and 6 milliseconds off for a bent tip). To verify this time as most efficient for a straight tip, we also tested times of 5, 6, and 7 milliseconds time on and off. The tips were either straight or with a 20-degree bend. Twenty cubes were used for each comparative run. For the straight tip, 6 milliseconds on (1.56 ± 0.815 seconds) was significantly more efficient than 7 milliseconds on (2.45 ± 1.56 seconds, p = 0.001) and not significantly more efficient than 5 milliseconds on (1.69 ± 0.86 seconds, p = 0.43). Five milliseconds off time (1.45 ± 0.76s) was more efficient than 6 milliseconds (2.06 ± 1.37 seconds, p = 0.004) and 7 milliseconds off (2.18 ± 1.24s, p = 0.001). The straight tip was more efficient than the bent tip (1.38 ± 0.83 versus 2.93 ± 2.14 seconds, p = 0.006). Results are contrary to accepted common belief. Micropulsed longitudinal phacoemulsification is more efficient with a straight rather than a bent tip. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Intraocular pressure, corneal thickness, and corneal hysteresis in Steinert's myotonic dystrophy

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Carlos Alexandre de A. Garcia Filho

2011-06-01

Full Text Available PURPOSE: Low intraocular pressure (IOP measured by Goldmann applanation tonometry (GAT is one of the ocular manifestations of Steinert's myotonic dystrophy. The goal of this study was to evaluate the corneal-compensated IOP as well as corneal properties (central corneal thickness and corneal hysteresis in patients with myotonic dystrophy. METHODS: A total of 12 eyes of 6 patients with Steinert's myotonic dystrophy (dystrophy group and 12 eyes of 6 age-, race-, and gender-matched healthy volunteers (control group were included in the study. GAT, Dynamic Contour Tonometry (DCT-Pascal and Ocular Response Analyzer (ORA were used to assess the IOP. Central corneal thickness was obtained by ultrasound pachymetry, and corneal hysteresis was analyzed using the ORA device. In light of the multiplicity of tests performed, the significance level was set at 0.01 rather than 0.05. RESULTS: The mean (standard deviation [SD] GAT, DCT, and corneal-compensated ORA IOP in the dystrophy group were 5.4 (1.4 mmHg, 9.7 (1.5 mmHg, and 10.1 (2.6 mmHg, respectively. The mean (SD GAT, DCT, and corneal-compensated ORA IOP in the control group was 12.6 (2.9 mmHg, 15.5 (2.7 mmHg, and 15.8 (3.4 mmHg, respectively. There were significant differences in IOP values between dystrophy and control groups obtained by GAT (mean, -7.2 mmHg; 99% confidence interval [CI], -10.5 to -3.9 mmHg; P<0.001, DCT (mean, -5.9 mmHg; 99% CI, -8.9 to -2.8 mmHg; P<0.001, and corneal-compensated ORA measurements (mean, -5.7 mmHg; 99% CI, -10.4 to -1.0 mmHg; P=0.003. The mean (SD central corneal thickness was similar in the dystrophy (542 [31] µm and control (537 [11] µm groups (P=0.65. The mean (SD corneal hysteresis in the dystrophy and control groups were 11.2 (1.5 mmHg and 9.7 (1.2 mmHg, respectively (P=0.04. CONCLUSIONS: Patients with Steinert's myotonic dystrophy showed lower Goldmann and corneal-compensated IOP in comparison with healthy individuals. Since central corneal thickness and

Clinical observation of capsular tension ring implantation in congenital lens subluxation treating by phacoemulsification

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Liang-Nan Sun

2017-07-01

Full Text Available AIM: To evaluate the clinical results of capsular tension ring(CTRimplantation in phacoemulsification for eyes with congenital lens subluxation. METHODS: This study comprised 18 patients(31 eyeswith congenital ectopia lentis. All patients received phacoemulsification with CTR and intraocular lens(IOLimplantation. Visual acuity before and after surgery were examined. IOL decentration were measured with Image-Pro Plus image processing software. The complications were also recorded preoperatively and postoperatively. RESULTS: Uncorrected vision of all eyes increased after surgery, and all cases had different degree of IOL decentration after surgery. Two eyes received CTR scleral fixation 3mo after surgery because the IOL decentration aggravated during the follow-up period. CONCLUSION: Phacoemulsification with CTR and IOL implantation is effective and safe for congenital lens subluxation. The implantation of CTR increase the stability of the capsular bag, improve the safety of surgery, and maintain the right position of IOL. CTR scleral fixation is a effective supplement for progressive cases.

Corneal edema and permanent blue discoloration of a silicone intraocular lens by methylene blue.

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Stevens, Scott; Werner, Liliana; Mamalis, Nick

2007-01-01

To report a silicone intraocular lens (IOL) stained blue by inadvertent intraoperative use of methylene blue instead of trypan blue and the results of experimental staining of various lens materials with different concentrations of the same dye. A "blue dye" was used to enhance visualization during capsulorhexis in a patient undergoing phacoemulsification with implantation of a three-piece silicone lens. Postoperatively, the patient presented with corneal edema and a discolored IOL. Various IOL materials were experimentally stained using methylene blue. Sixteen lenses (4 silicone, 4 hydrophobic acrylic, 4 hydrophilic acrylic, and 4 polymethylmethacrylate) were immersed in 0.5 mL of methylene blue at concentrations of 1%, 0.1%, 0.01%, and 0.001%. These lenses were grossly and microscopically evaluated for discoloration 6 and 24 hours after immersion. The corneal edema resolved within 1 month after the initial surgical procedure. After explantation, gross and microscopic analyses of the explanted silicone lens revealed that its surface and internal substance had been permanently stained blue. In the experimental study, all of the lenses except the polymethylmethacrylate lenses were permanently stained by methylene blue. The hydrophilic acrylic lenses showed the most intense blue staining in all dye concentrations. This is the first clinicopathological report of IOL discoloration due to intraocular use of methylene blue. This and other tissue dyes may be commonly found among surgical supplies in the operating room and due diligence is necessary to avoid mistaking these dyes for those commonly used during ocular surgery.

Intrastromal corneal ring implants for corneal thinning disorders: an evidence-based analysis.

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2009-01-01

The purpose of this project was to determine the role of corneal implants in the management of corneal thinning disease conditions. An evidence-based review was conducted to determine the safety, effectiveness and durability of corneal implants for the management of corneal thinning disorders. The evolving directions of research in this area were also reviewed. SUBJECT OF THE EVIDENCE-BASED ANALYSIS: The primary treatment objectives for corneal implants are to normalize corneal surface topography, improve contact lens tolerability, and restore visual acuity in order to delay or defer the need for corneal transplant. Implant placement is a minimally invasive procedure that is purported to be safe and effective. The procedure is also claimed to be adjustable, reversible, and both eyes can be treated at the same time. Further, implants do not limit the performance of subsequent surgical approaches or interfere with corneal transplant. The evidence for these claims is the focus of this review. The specific research questions for the evidence review were as follows: SafetyCorneal Surface Topographic Effects:Effects on corneal surface remodellingImpact of these changes on subsequent interventions, particularly corneal transplantation (penetrating keratoplasty [PKP])Visual AcuityRefractive OutcomesVISUAL QUALITY (SYMPTOMS): such as contrast vision or decreased visual symptoms (halos, fluctuating vision)Contact lens toleranceFunctional visual rehabilitation and quality of lifePatient satisfaction:Disease Process:Impact on corneal thinning processEffect on delaying or deferring the need for corneal transplantation TARGET POPULATION AND CONDITION Corneal ectasia (thinning) comprises a range of disorders involving either primary disease conditions such as keratoconus and pellucid marginal corneal degeneration or secondary iatrogenic conditions such as corneal thinning occurring after LASIK refractive surgery. The condition occurs when the normally round dome-shaped cornea

Refractive aim and visual outcome after phacoemulsification: A 2 ...

African Journals Online (AJOL)

Common ocular comorbidities excluded were corneal opacity/corneal scar, glaucoma, uveitis, pseudo exfoliation syndrome, moderate and severe nonproliferative diabetic retinopathy, macula edema, proliferative diabetic retinopathy, eye trauma, age‑related macular degeneration, previous corneal surgery, glaucoma ...

Intraoperative corneal thickness measurements during corneal collagen cross-linking with isotonic riboflavin solution without dextran in corneal ectasia.

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Cınar, Yasin; Cingü, Abdullah Kürşat; Sahin, Alparslan; Türkcü, Fatih Mehmet; Yüksel, Harun; Caca, Ihsan

2014-03-01

Abstract Objective: To monitor the changes in corneal thickness during the corneal collagen cross-linking procedure by using isotonic riboflavin solution without dextran in ectatic corneal diseases. The corneal thickness measurements were obtained before epithelial removal, after epithelial removal, following the instillation of isotonic riboflavin solution without dextran for 30 min, and after 10 min of ultraviolet A irradiation. Eleven eyes of eleven patients with progressive keratoconus (n = 10) and iatrogenic corneal ectasia (n = 1) were included in this study. The mean thinnest pachymetric measurements were 391.82 ± 30.34 µm (320-434 µm) after de-epithelialization of the cornea, 435 ± 21.17 µm (402-472 µm) following 30 min instillation of isotonic riboflavin solution without dextran and 431.73 ± 20.64 µm (387-461 µm) following 10 min of ultraviolet A irradiation to the cornea. Performing corneal cross-linking procedure with isotonic riboflavin solution without dextran might not induce corneal thinning but a little swelling throughout the procedure.

Recent advances in femtosecond laser-assisted cataract surgery

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Zhao-Jie Chu

2013-07-01

Full Text Available Perfect vision and fewer complications is our goal in cataract surgery, femtosecond laser-assisted cataract surgery hold the promise. Applications of femtosecond laser technology for capsulotomy, nuclear fragmentation and corneal incision in cataract surgery bring a new level of accuracy, reproducibility and predictability over the current cataract surgery. The femtosecond laser produces capsulotomies that are more precise, accurate, reproducible, and stronger than those created with the conventional manual technique, and further helps maintain proper positioning of the IOL. Femtosecond laser in nuclear fragmentation lead to a lower effective phacoemulsification time, and the corneal incision is more stable. But currently there are some complications and a clear learning curve associated with the use of femtosecond lasers for cataract surgery. The long-term safety and visual outcomes still need further investigation.

Measuring performance in virtual reality phacoemulsification surgery

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Söderberg, Per; Laurell, Carl-Gustaf; Simawi, Wamidh; Skarman, Eva; Nordh, Leif; Nordqvist, Per

2008-02-01

We have developed a virtual reality (VR) simulator for phacoemulsification surgery. The current work aimed at developing a relative performance index that characterizes the performance of an individual trainee. We recorded measurements of 28 response variables during three iterated surgical sessions in 9 experienced cataract surgeons, separately for the sculpting phase and the evacuation phase of phacoemulsification surgery and compared their outcome to that of a reference group of naive trainees. We defined an individual overall performance index, an individual class specific performance index and an individual variable specific performance index. We found that on an average the experienced surgeons performed at a lower level than a reference group of naive trainees but that this was particularly attributed to a few surgeons. When their overall performance index was further analyzed as class specific performance index and variable specific performance index it was found that the low level performance was attributed to a behavior that is acceptable for an experienced surgeon but not for a naive trainee. It was concluded that relative performance indices should use a reference group that corresponds to the measured individual since the definition of optimal surgery may vary among trainee groups depending on their level of experience.

Clinical investigation on angle-closure glaucoma patients with cataract treated by phacoemulsification combined with trabeculectomy

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Yu-Sheng Wang

2013-11-01

Full Text Available AIM: To investigate the effectiveness of phacoemulsification with intraocular lens(IOLimplantation combined with trabeculectomy in patients with cataract and angle-closure glaucoma.METHODS: In 36 cases(46 eyesof angle-closure glaucoma with cataract, phacoemulsification with foldable IOL implantation combined with trabeculectomy was performed. Data of pre- and post-operation, including visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, chamber angle, and funds were all recorded and analyzed in detail.RESULTS: During the follow-up of 3 months to 2 years,visual acuity of 43 eyes(93.5%got improved, and intraocular pressure in 44 eyes(95.7%were controlled in normal range(CONCLUSION: Phacoemulsification with IOL implantation combined with trabeculectomy is an effective and safe surgical technique for patients with angle-closure glaucoma and cataract, with satisfied control of intraocular pressure, deepening of anterior chamber, opening of anterior chamber angle, and improving visual function.

Time course of development of posterior vitreous detachments after phacoemulsification surgery.

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Hikichi, Taiichi

2012-10-01

To determine when posterior vitreous detachments (PVDs) develop after phacoemulsification and aspiration combined with foldable intraocular lens implantation. Prospective, consecutive case series. A total of 575 eyes without a PVD preoperatively were studied prospectively and followed for 3 years after uneventful phacoemulsification surgery. All patients underwent a comprehensive ocular examination, including a dynamic vitreous examination using biomicroscopy with and without a preset lens and a preoperative retinal examination on the day of surgery; the day postoperatively; 1 week and 1, 3, 6, and 12 months postoperatively; and every 6 months for 3 years postoperatively. The patients were divided into groups and analyzed on the basis of age and refractive error or axial length. The cumulative incidence rates of eyes that developed PVD for 3 years postoperatively at each postoperative time point. The cumulative numbers and percentages of eyes that developed a PVD were 6 (1.0%), 18 (3.1%), 31 (5.4%), 45 (7.8%), 63 (11.0%), 88 (15.3%), 106 (18.4%), 133 (23.1%), and 172 (30.0%) within 1 week and 1, 3, 6, 12, 18, 24, 30, and 36 months, respectively. Eleven (6.4%) of the 172 eyes in which a PVD developed during the follow-up period had new retinal breaks with or without a retinal detachment. Eight (15.4%) of 52 eyes with lattice degeneration and 3 (2.5%) of 120 eyes without lattice degeneration had retinal breaks associated with a PVD; these percentages were significant (P = 0.003). Development of PVDs seems to accelerate after phacoemulsification and linearly accumulated for 3 years postoperatively. Approximately 6% of eyes with a PVD had retinal breaks and eyes with lattice degeneration had a 6.2-fold higher risk of developing retinal breaks associated with a PVD. Long-term follow-up is needed after phacoemulsification is performed. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Application of diffractive aspheric multifocal intraocular lens in the Uighur in phacoemulsification

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Nuersimanguli·Mijiti

2016-05-01

Full Text Available AIM:To research the efficacy and safety of diffractive aspheric multifocal intraocular lens(MIOLin the Uighur in phacoemulsification to provide guidance for the clinical treatment of cataracts patients in Xinjiang region. METHODS:Two hundred and twenty-eight Uygur patients(280 eyesreceived phacoemulsification from April 2012 to March 2013 were randomly divided into multifocal group(106 cases with 146 eyesand monofocal group(122 cases with 134 eyes. Patients were followed up for 3mo. The intraocular pressure(IOP, uncorrected distance visual acuity, uncorrected near vision, best-corrected distance visual acuity and best corrected near vision were measured. The delensed rate, visual quality, and satisfaction for lenses in the form of questionnaires were compared. RESULTS:Multifocal group was better on the uncorrected near vision than monofocal group(PP>0.05. The contrast sensitivity of multifocal group under scotopia at spatial frequency 3c/d was lower than that of monofocal group(PP>0.05. Delensed rate of multifocal group was higher than that of monofocal group(PP>0.05.CONCLUSION:MIOL with phacoemulsification can provide patient good full range vision, especially on good near vision. The patients with MIOL implanted have a higher delensed rate, less postoperative adverse symptoms, quicker recovery and satisfaction.

Er:YAG phacoemulsification with fiber

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Cozean, Colette D.

1994-07-01

Forty years ago, a leading cataract surgeon in the United States announced, with an air of finality, that the "perfect operation' for cataract extraction had been developed.' He believed cataract surgeons had reached their zenith and that no more time should be wasted looking for alternatives or refinements. The procedure he was describing was an intracapsular cataract extraction. The cataract was delivered at that time with forceps, often with "just a little vitreous". Sutures were just beginning to be used, but weeks of postoperative immobilization were still the norm. Patients undergoing the procedure could look forward to a lifetime of visual impairment and to a loss of confidence and self-esteem brought about by both the functional impairment and the unflattering appearance of these spectacles. This "perfect operation" marked the end of the productive life for most individuals. With the introduction of the first ultrasonic phacoemulsification equipment in the 1970's and the development of small incision intraocular lenses in the 1980's, all of us have witnessed a remarkable leap in the evolution of cataract surgery. Like our colleague forty years ago, some of us think that we have reached a plateau, but this evolution will continue. What is needed in ophthalmic surgery today is a single, versatile, reliable, and inexpensive multipurpose device which can perform all these surgical functions with equivalent or superior results. Such a device would allow cost-conscious surgery facilities to offer a full range of state-of-the-art surgery, while purchasing only a single unit - a unit which would be no more expensive than existing phacoemulsification devices.

CLINICAL OUTCOME OF PENETRATING KERATOPLASTY IN CORNEAL OPACITIES OF DIFFERENT AETIOLOGY- A CLINICAL STUDY

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Dipak Bhuyan

2017-01-01

Full Text Available BACKGROUND Corneal transplantation or grafting is an operation in which abnormal corneal host tissue is replaced by healthy donor cornea. According to the World Health Organization (WHO, corneal diseases are among the major causes of vision loss and blindness in the world today after cataract and glaucoma. The aim of the study is to- 1. Evaluate the different aetiology of corneal opacity including active infective aetiology as indicated for penetrating keratoplasty. 2. Determine the clinical outcome of penetrating keratoplasty in relation to graft survival, graft rejection and peri-operative complications in different aetiology groups. 3. Determine the final visual outcome. MATERIALS AND METHODS Candidates for keratoplasty were selected from- 1. Eye Bank of Regional Institute of Ophthalmology (R.I.O. 2. R.I.O OPD. The study period was from September 2014 to August 2015. 30 cases were taken in the study. Descriptive statistics were applied to analyse the data wherever necessary. RESULTS 34.6±19.73 yrs. (mean±SD was the mean age at which transplants were done in the study. Out of total 30 cases, 13 (43.33% and 17 (56.66% were male and female, respectively. The different indications for penetrating keratoplasty are- Post ulcer corneal opacity in 14 cases (46.66%, posttraumatic corneal opacity 9 cases (30%, pseudophakic bullous keratopathy 4 cases (13.33%, corneal dystrophy in 2 cases (6.66% and non-healing corneal ulcer in 1 case (3.33%. 16 cases (53.33% showed clear graft till the last follow up while 11 (33.33% cases showed partially clear graft resulting in improved visual outcome while 3 cases (10.00% of the grafts were opaque due to graft failure. CONCLUSION The major indications for penetrating keratoplasty in this part of the world are post ulcer and posttraumatic corneal opacity and majority of them are illiterate agricultural workers who failed to get adequate treatment on time. Graft survival rate is high, which can be attributed to the

The risk of ischemic optic neuropathy post phacoemulsification cataract surgery.

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Al-Madani, Mousa Victor; Al-Raqqad, Nancy Khalaf; Al-Fgarra, Naser Abdallah; Al-Thawaby, Amal Mousa; Jaafar, Ahmed Abdelra'of

2017-01-01

The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. This study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. A total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. Phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.

Combined Phacoemulsification, Vitrectomy and Endolaser Photocoagulation in Patients with Diabetic Retinopathy and Cataract

International Nuclear Information System (INIS)

Wahab, S; Hargun, L. D.

2014-01-01

Objective: To determine the outcomes of early vitrectomy and endolaser photocoagulation effects during phacoemulsification in cataractous eyes with diabetic retinopathy. Study Design: Descriptive study. Place and Duration of Study: Ophthalmology Department Unit-II, DUHS, Civil Hospital, Karachi, and Al-Noor Eye Clinic, Karachi, from February 2009 to December 2010. Methodology: Consecutive 54 patients with 7 - 15 years duration of type II diabetes with severe non-proliferative diabetic retinopathy (NPDR) and early proliferative diabetic retinopathy (PDR) who had cataract grade I and II underwent vitrectomy, endolaser photocoagulation and phacoemulsification with IOL implantation. Best corrected visual acuity was main outcomes measure assessed till 6 months follow-up. Results: Out of 54 eyes, 32 patients were females and 22 were males. Majority 47 (87%) eyes gained significant (p < 0.001) improvement of best corrected visual acuity of four lines or better while 5 (9.3%) eyes retained stable visual acuity. In only 2 eyes, vision declined to 3/60 or less. Conclusion: Early vitrectomy with phacoemulsification in severe NPDR and early PDR patients, if assisted or augmented with endolaser photocoagulation, maximizes, early visual rehabilitation with less morbidity and may retard progression of retinopathy. (author)

Equine corneal stromal abscesses

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Henriksen, M. D. L.; Andersen, P. H.; Plummer, C. E.

2013-01-01

The last 30 years have seen many changes in the understanding of the pathogenesis and treatment of equine corneal stromal abscesses (SAs). Stromal abscesses were previously considered an eye problem related to corneal bacterial infection, equine recurrent uveitis, corneal microtrauma and corneal....... Medical and surgical treatments are now directed towards elimination of fungal and bacterial infections, reduction and replacement of diseased corneal stroma, and suppression of iridocyclitis. If the abscess and anterior uveitis do not respond satisfactorily to medical therapy, full thickness or split...

Dynamic corneal deformation response and integrated corneal tomography

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Marcella Q Salomão

2018-01-01

Full Text Available Measuring corneal biomechanical properties is still challenging. There are several clinical applications for biomechanical measurements, including the detection of mild or early forms of ectatic corneal diseases. This article reviews clinical applications for biomechanical measurements provided by the Corvis ST dynamic non contact tonometer

Ab interno trabeculectomy: patient selection and perspectives

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Vinod, Kateki; Gedde, Steven J

2016-01-01

Ab interno trabeculectomy is one among several recently introduced minimally invasive glaucoma surgeries that avoid a conjunctival incision and full-thickness sclerostomy involved in traditional glaucoma surgery. Ablation of the trabecular meshwork and inner wall of Schlemm’s canal is performed in an arcuate fashion via a clear corneal incision, alone or in combination with phacoemulsification cataract surgery. Intraocular pressure reduction following ab interno trabeculectomy is limited by resistance in distal outflow pathways and generally stabilizes in the mid-to-high teens. Relief of medication burden has been demonstrated by some studies. A very low rate of complications, most commonly transient hyphema and intraocular pressure elevations in the immediate postoperative period, have been reported. However, available data are derived from small retrospective and prospective case series. Randomized, controlled trials are needed to better elucidate the potential merits of ab interno trabeculectomy in the combined setting versus phacoemulsification cataract surgery alone and to compare it with other minimally invasive glaucoma surgeries. PMID:27574396

Ocular dimensions, corneal thickness, and corneal curvature in quarter horses with hereditary equine regional dermal asthenia.

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Badial, Peres R; Cisneros-Àlvarez, Luis Emiliano; Brandão, Cláudia Valéria S; Ranzani, José Joaquim T; Tomaz, Mayana A R V; Machado, Vania M; Borges, Alexandre S

2015-09-01

The aim of this study was to compare ocular dimensions, corneal curvature, and corneal thickness between horses affected with hereditary equine regional dermal asthenia (HERDA) and unaffected horses. Five HERDA-affected quarter horses and five healthy control quarter horses were used. Schirmer's tear test, tonometry, and corneal diameter measurements were performed in both eyes of all horses prior to ophthalmologic examinations. Ultrasonic pachymetry was performed to measure the central, temporal, nasal, dorsal, and ventral corneal thicknesses in all horses. B-mode ultrasound scanning was performed on both eyes of each horse to determine the dimensions of the ocular structures and to calculate the corneal curvature. Each corneal region examined in this study was thinner in the affected group compared with the healthy control group. However, significant differences in corneal thickness were only observed for the central and dorsal regions. HERDA-affected horses exhibited significant increases in corneal curvature and corneal diameter compared with unaffected animals. The ophthalmologic examinations revealed mild corneal opacity in one eye of one affected horse and in both eyes of three affected horses. No significant between-group differences were observed for Schirmer's tear test, intraocular pressure, or ocular dimensions. Hereditary equine regional dermal asthenia-affected horses exhibit decreased corneal thickness in several regions of the cornea, increased corneal curvature, increased corneal diameter, and mild corneal opacity. Additional research is required to determine whether the increased corneal curvature significantly impacts the visual accuracy of horses with HERDA. © 2014 American College of Veterinary Ophthalmologists.

Efficacy of Tectonic Corneal Patch Graft for Progressive Peripheral Corneal Thinning

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Cafer Tanrıverdio

2014-12-01

Full Text Available Objectives: To report the results of tectonic corneal patch graft (TCPG in patients with progressive peripheral corneal thinning (PCT. Materials and Methods: In this study, we included 8 patients who underwent TCPG for PCT or perforated corneal ulceration at Ankara Training and Research Hospital. Results: We performed TCPG in 7 patients for PCT and in 1 patient for perforated corneal ulceration. Mean age was 57.2±16.7 (38- 82 years. Postoperative follow-up time ranged from 6 to 24 months (mean 13.9±6.7. Possible etiologies leading to progressive PCT were trachoma, infectious corneal ulcer, and rheumatoid arthritis-severe dry eye in 2 patients each. Other 2 patients had a progressive PCT following ocular surgery. One of the patients with infectious corneal ulcer also had a trauma caused by a scissor. Amnion membrane transplantation was performed in 3 patients prior to TCPG. While the anatomic success was achieved in all 8 patients, best-corrected visual acuity (BCVA was 0.1 or better in 4 patients (50%. Postoperative BCVA was better than preoperative BCVA in 6 patients (75%. Local peripheral anterior synechiae developed in two eyes. Conclusion: TCPG is a useful therapeutic option in selected cases of corneal thinning and perforations because it effectively restores the integrity of the globe and allows acceptable visual results. (Turk J Ophthalmol 2014; 44: 440-4

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

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Ng DS

2018-05-01

Full Text Available Danny Siu-Chun Ng,1 Zihan Sun,1 Alvin Lerrmann Young,1,2 Simon Tak-Chuen Ko,3 Jerry Ka-Hing Lok,1 Timothy Yuk-Yau Lai,1 Shameema Sikder,4 Clement C Tham1 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 2Department of Ophthalmology, Prince of Wales Hospital, 3Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, People’s Republic of China; 4Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA Objective: To identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. Design: The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR, using a 5-point Likert scale (1 = least and 5 = most difficulty, was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1 higher level trainee, 2 can complete phacoemulsification most of the time (>90% without supervisor’s intervention, and 3 prior simulation training. Setting: The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Results: Of the 22 residents, 19 responded (86.3%, of which 13 (68.4% had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by

Construction of a human corneal stromal equivalent with non-transfected human corneal stromal cells and acellular porcine corneal stromata.

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Diao, Jin-Mei; Pang, Xin; Qiu, Yue; Miao, Ying; Yu, Miao-Miao; Fan, Ting-Jun

2015-03-01

A tissue-engineered human corneal stroma (TE-HCS) has been developed as a promising equivalent to the native corneal stroma for replacement therapy. However, there is still a crucial need to improve the current approaches to render the TE-HCS equivalent more favorable for clinical applications. At the present study, we constructed a TE-HCS by incubating non-transfected human corneal stromal (HCS) cells in an acellular porcine corneal stromata (aPCS) scaffold in 20% fetal bovine serum supplemented DMEM/F12 (1:1) medium at 37 °C with 5% CO2in vitro. After 3 days of incubation, the constructed TE-HCS had a suitable tensile strength for transplantation, and a transparency that is comparable to native cornea. The TE-HCS had a normal histological structure which contained regularly aligned collagen fibers and differentiated HCS cells with positive expression of marker and functional proteins, mimicking a native HCS. After transplantation into rabbit models, the TE-HCS reconstructed normal corneal stroma in vivo and function well in maintaining corneal clarity and thickness, indicating that the completely biological TE-HCS could be used as a HCS equivalent. The constructed TE-HCS has promising potentials in regenerative medicine and treatment of diseases caused by corneal stromal disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of the Femtosecond Laser in Line with the Femtosecond Laser-Assisted Cataract Surgery (FLACS) on the Anterior Chamber Characteristics in Comparison to the Manual Phacoemulsification.

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Pahlitzsch, Milena; Torun, Necip; Pahlitzsch, Marie Luise; Klamann, Matthias K J; Gonnermann, Johannes; Bertelmann, Eckart; Pahlitzsch, Thomas

2017-01-01

To assess the alterations of the anterior chamber conditions including laser flare photometry after femtosecond laser-assisted cataract surgery (FLACS) compared to the manual phacoemulsification. Data of n=70 FLACS (mean age 67.2 ± 8.9 years) and n=40 manual phacoemulsification (mean age 69.5 ± 9.6 years) were analyzed. The procedures were performed by LenSx Alcon, USA, and Alcon Infiniti Vision System, USA. The following parameters were recorded: laser flare photometry (Kowa FM 700, Japan), anterior chamber (AC) depth, AC volume, AC angle (Pentacam, Oculus Inc., Germany), lens density, pupil diameter, endothelial cell count and pachymetry. The analysis was performed preoperatively, immediately after femtosecond laser procedure and one day postoperatively. Between FLACS and the phaco control group, there was a significant difference in the AC depth (p=0.023, 3.77 mm vs. 4.05 mm) one day postoperatively. The AC angle (p=0.016) showed a significant difference immediately after the femto laser treatment. The central and thinnest pachymetry and endothelial cell count did not show a significant difference between the two study cohorts (p=0.165, p=0.291, p=0.979). The phaco cohort (n=40) demonstrated a non-statistically significant difference in the flare photometry of 15.80 photons/ms one postoperative day compared to the FLACS group 26.62 photons/ms (p=0.322). In this study population, no evidence for an additive damage caused by the use of the femtosecond laser was demonstrated. Furthermore, no increase in the central and thinnest corneal thickness and no increased endothelial cell loss was demonstrated by the laser energy.

Corneal Laceration

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Full Text Available ... Tips & Prevention News Ask an Ophthalmologist Patient Stories Español Eye Health / Eye Health A-Z Corneal Laceration ... Laceration Treatment What Is Corneal Laceration? Leer en Español: ¿Qué es una laceración de la córnea? Written ...

Keratocyte apoptosis and corneal antioxidant enzyme activities after refractive corneal surgery.

Science.gov (United States)

Bilgihan, K; Bilgihan, A; Adiguzel, U; Sezer, C; Yis, O; Akyol, G; Hasanreisoglu, B

2002-01-01

Refractive corneal surgery induces keratocyte apoptosis and generates reactive oxygen radicals (ROS) in the cornea. The purpose of the present study is to evaluate the correlation between keratocyte apoptosis and corneal antioxidant enzyme activities after different refractive surgical procedures in rabbits. Rabbits were divided into six groups. All groups were compared with the control group (Group 1), after epithelial scraping (Group 2), epithelial scrape and photorefractive keratectomy (PRK) (traditional PRK: Group 3), transepithelial PRK (Group 4), creation of a corneal flap with microkeratome (Group 5) and laser-assisted in situ keratomileusis (LASIK, Group 6). Terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labelling assay (to detect DNA fragmentation in situ) and light microscopy were used to detect apoptosis in rabbit eyes. Glutathione peroxidase (Gpx) and superoxide dismutase (SOD) activities of the corneal tissues were measured with spectrophotometric methods. Corneal Gpx and SOD activities decreased significantly in all groups when compared with the control group (P<0.05) and groups 2, 3 and 6 showed a significantly higher amount of keratocyte apoptosis (P<0.05). Not only a negative correlation was observed between corneal SOD activity and keratocyte apoptosis (cc: -0.3648) but Gpx activity also showed negative correlation with keratocyte apoptosis (cc: -0.3587). The present study illustrates the negative correlation between keratocyte apoptosis and corneal antioxidant enzyme activities. This finding suggests that ROS may be partly responsible for keratocyte apoptosis after refractive surgery.

Phacoemulsification versus small incision cataract surgery in patients with uveitis

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Rahul Bhargava

2015-10-01

Full Text Available AIM: To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS in patients with uveitic cataract.METHODS:In aprospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI. A P value of <0.05 was considered statistically significant.RESULTS:One hundred and twenty-six of 139 patients (90.6% completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1 or inability implant an intraocular lens (IOL because of insufficient capsular support following posterior capsule rupture (n=5. There was significant improvement in vision after both the procedures (paired t-test; P<0.001. On first postoperative day, uncorrected distance visual acuity (UDVA was 20/63 or better in 31 (47% patients in Phaco group and 26 (43.3% patients in SICS group (P=0.384. The mean surgically induced astigmatism (SIA was 0.86±0.34 dioptres (D in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002. At 6mo, corrected distance visual acuity (CDVA

Determining the local origin of hydroxyl radical generation during phacoemulsification.

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Aust, Steven D; Terry, Scott; Hebdon, Thomas; Gunderson, Broc; Terry, Michael; Dimalanta, Ramon

2011-06-01

To determine the local origin of hydroxyl radicals during phacoemulsification using an ultrasonic phacoemulsification device that includes longitudinal and torsional modalities. Chemistry and Biochemistry Department, Utah State University, Logan, Utah, USA. Experimental study. Experiments were conducted using the Infiniti Vision System and Ozil handpiece. Hydroxyl radical concentrations during longitudinal and torsional phacoemulsification were quantitated as malondialdehyde (MDA) determined spectrophotometrically using the deoxyribose assay. The difference between the total concentration found in the aspirated solution at steady-state concentrations and the pre-aspirate levels deductively determined the concentration of MDA formed along the interior of the sonicating tip. The time to reach 50% of steady state as a function of reaction vessel volume was determined. The mean maximum for torsional ultrasound at 100% amplitude was 7.70 nM ± 0.38 (SD), 91.1% of which was generated outside the tip. During longitudinal ultrasound at 100% power, MDA concentration in the aspirated solution was 29.5 ± 0.3 nM, 71.6% of which was generated outside the tip. The time (seconds) to reach 50% of maximum for longitudinal ultrasound using 5 mL, 10 mL, and 20 mL reaction vessels was 12.6 ± 1.5, 21.0 ± 1.5, and 25.3 ± 3.4, respectively. Although a significantly greater proportion of the hydroxyl radicals generated during ultrasound modality were formed outside the phaco tip (91.1% torsional; 71.6% longitudinal), torsional ultrasound generated only about one-fourth the amount of MDA as longitudinal ultrasound in total and about one-third that generated outside the tip (7.02 nM versus 21.1 nM). No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Learning phacoemulsification. Results of different teaching methods.

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Hennig Albrecht

2004-01-01

Full Text Available We report the learning curves of three eye surgeons converting from sutureless extracapsular cataract extraction to phacoemulsification using different teaching methods. Posterior capsule rupture (PCR as a per-operative complication and visual outcome of the first 100 operations were analysed. The PCR rate was 4% and 15% in supervised and unsupervised surgery respectively. Likewise, an uncorrected visual acuity of > or = 6/18 on the first postoperative day was seen in 62 (62% of patients and in 22 (22% in supervised and unsupervised surgery respectively.

Cornea stress test--evaluation of corneal endothelial function in vivo by contact lens induced stress

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Saini Jagjit

1997-01-01

Full Text Available Reliable and valid assessment of corneal endothelial function is a critical input for diagnosing, prognosticating and monitoring progression of disorders affecting corneal endothelium. In 123 eyes, corneal endothelial function was assessed employing data from the corneal hydration recovery dynamics. Serial pachometric readings were recorded on Haag-Striet pachometer with Mishima-Hedbys modification before and after two hours of thick soft contact lens wear. Percentage Recovery Per Hour (PRPH was derived from raw data as an index of endothelial function. Assessed PRPH in pseudophakic corneal oedema and Fuchs′ endothelial dystrophy eyes (35.9 +/- 9.8% was significantly lower than normal controls (61.9 +/- 10.5%. On employing receiver operation characteristics curve analysis the tested results demonstrated high sensitivity (87% and specificity (92% for detection of low endothelial function at PRPH cut off of 47.5%. Using this PRPH cut off, 80% of Fuchs′ endothelial dystrophy and 93.3% of pseudophakic corneal oedema eyes could be demonstrated to have low endothelial function. A total of 66.7% of diabetic eyes also demonstrated PRPH of lower than 47.5%. Clear corneal grafts demonstrated PRPH values of 24.6% to 73.0%. Of 6 corneal grafts that demonstrated initial PRPH of lower than 47.5%, 4 failed within 4 to 6 months. Our data demonstrated high sensitivity and specificity of this corneal stress test. PRPH index was useful in quantifying endothelial function in clinical disorders including diabetes mellitus. The index PRPH was demonstrated to be useful in monitoring and prognosticating outcome of corneal grafts.

A VidEo-Based Intelligent Recognition and Decision System for the Phacoemulsification Cataract Surgery

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Shu Tian

2015-01-01

Full Text Available The phacoemulsification surgery is one of the most advanced surgeries to treat cataract. However, the conventional surgeries are always with low automatic level of operation and over reliance on the ability of surgeons. Alternatively, one imaginative scene is to use video processing and pattern recognition technologies to automatically detect the cataract grade and intelligently control the release of the ultrasonic energy while operating. Unlike cataract grading in the diagnosis system with static images, complicated background, unexpected noise, and varied information are always introduced in dynamic videos of the surgery. Here we develop a VidEo-Based Intelligent Recognitionand Decision (VEBIRD system, which breaks new ground by providing a generic framework for automatically tracking the operation process and classifying the cataract grade in microscope videos of the phacoemulsification cataract surgery. VEBIRD comprises a robust eye (iris detector with randomized Hough transform to precisely locate the eye in the noise background, an effective probe tracker with Tracking-Learning-Detection to thereafter track the operation probe in the dynamic process, and an intelligent decider with discriminative learning to finally recognize the cataract grade in the complicated video. Experiments with a variety of real microscope videos of phacoemulsification verify VEBIRD’s effectiveness.

Bioactive Antimicrobial Peptides as Therapeutics for Corneal Wounds and Infections.

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Griffith, Gina L; Kasus-Jacobi, Anne; Pereira, H Anne

2017-06-01

Significance: More than 2 million eye injuries and infections occur each year in the United States that leave civilians and military members with reduced or complete vision loss due to the lack of effective therapeutics. Severe ocular injuries and infections occur in varied settings including the home, workplace, and battlefields. In this review, we discuss the potential of developing antimicrobial peptides (AMPs) as therapeutics for the treatment of corneal wounds and infections for which the current treatment options are inadequate. Recent Advances: Standard-of-care employs the use of fluorescein dye for the diagnosis of ocular defects and is followed by the use of antibiotics and/or steroids to treat the infection and reduce inflammation. Recent advances for treating corneal wounds include the development of amniotic membrane therapies, wound chambers, and drug-loaded hydrogels. In this review, we will discuss an innovative approach using AMPs with the dual effect of promoting corneal wound healing and clearing infections. Critical Issues: An important aspect of treating ocular injuries is that treatments need to be effective and administered expeditiously. This is especially important for injuries that occur during combat and in individuals who demonstrate delayed wound healing. To overcome gaps in current treatment modalities, bioactive peptides based on naturally occurring cationic antimicrobial proteins are being investigated as new therapeutics. Future Directions: The development of new therapeutics that can treat ocular infections and promote corneal wound healing, including the healing of persistent corneal epithelial defects, would be of great clinical benefit.

Clinical research on the development of posterior vitreous detachments after coaxial microincision phacoemulsification

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Rong Xu

2013-09-01

Full Text Available AIM: To explore the development process of when posterior vitreous detachments(PVDsafter coaxial micro-incision phacoemulsification and aspiration combined with foldable intraocular lens implantation.METHODS: Clinical data of 917 patients with cataract were collected after coaxial microincision phacoemulsification and aspiration combined with foldable intraocular lens implantation. The 917 operating eyes forms observation group and the 917 corresponding normal eyes serve as control group. All patients underwent a comprehensive ocular examination before surgery. The vitreous and retinal condition was tested by B-scan ultrasonography and biomicroscope with a 90-diopter(Dpreset lens after 1 week and 1, 3, 6, and 12 months postoperatively. RESULTS: The incident rate of eyes in the observation group that developed PVD after operation were 8(0.9%, 31(3.4%, 53(5.8%, 78(8.5%, 129(14.1%within 1 week and 1, 3, 6, 12 months, respectively. Ten(7.8%of the 129 eyes in which PVD developed during the one year follow-up period had new retinal breaks with or without a retinal detachment; One(0.1%of the 788 eyes in which a PVD did not developed during the follow-up period had new retinal tear with or without a retinal detachment; these percentages were statistically significant(P=0.009. Eight(14.8%of 54 eyes with lattice degeneration and 2(2.7%of 75 eyes without lattice degeneration had retinal tears associated with a PVD; the difference was statistically significant(P=0.004.CONCLUSION: Development of PVDs seems to accelerate after coaxial microincision phacoemulsification and linearly accumulated for 1 year postoperatively. Approximately 7.8% of eyes with a PVD had retinal tears. Compared with patients having no lattice degeneration, Patients' eyes with lattice degeneration had a 5.5-fold higher risk of developing retinal breaks associated with a PVD. This indicates long-term follow-up is necessary after phacoemulsification is performed.

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems [Corrigendum

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Chen M

2015-08-01

Full Text Available Chen M, Anderson E, Hill G, et al. Clin Ophthalmol. 2015;9:1367–1372.  On page 1367, the final sentence of the Introduction which reads:  “The purpose of this study was simply to compare the CDE between the single Centurion and single Infiniti phacoemulsification systems in a larger number of cases to see which one uses less CDE under similar age, sex, and complication rate (P>0.05 among five surgeons in one surgical center.”    Should read:“The purpose of this study is to compare the mean CDE and complication rate of the Centurion and Infiniti phacoemulsification systems.”On page 1370 there were errors in both Figures 1 and 2. The correct figures are presented here. Read the original article

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

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Jesus Jimenez-Roman

2017-09-01

Full Text Available AIM: To compare the effect of phacoemulsification on intraocular pressure (IOP in patients with primary open angle glaucoma (POAG and pseudoexfoliation glaucoma (PXG. METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS: The study enrolled 88 patients (88 eyes. After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001. In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP was evidenced between groups (P=0.005. The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20% over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.

Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification.

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Chaudhry, Prashaant; Prakash, Gaurav; Jacob, Soosan; Narasimhan, Smita; Agarwal, Sunita; Agarwal, Amar

2010-12-01

To evaluate the safety and efficacy of gas-forced infusion (air pump) in uncomplicated coaxial phacoemulsification. Dr. Agarwal's Eye Hospital, Chennai, India. Comparative case series. Specular microscopy and optical coherence tomography were used to analyze the endothelium, central macular thickness (CMT), and peripapillary retinal nerve fiber layer (RNFL) thickness before and approximately 1, 7, 30, and 90 days after coaxial phacoemulsification with (infusion group) or without (control group) gas-forced infusion. Surgical time, surge, phaco energy, irrigation fluid volume, surgical ease, complications, and visual gain in the 2 groups were compared. The mean endothelial cell loss was lower in the infusion group than in the control group (6.98% ± 8.46% [SD] versus 10.54% ± 11.24%; P = .045) and the irrigation/aspiration time significantly shorter (54 ± 39 seconds versus 105 ± 84 seconds; P = .0001). The surgery was rated as easier with gas-forced infusion (scale 1 to 10: mean 8.3 ± 2.1 versus 6.6 ± 1.6; P = .00002). However, the amount of irrigating fluid volume was higher in the infusion group (117 ± 37 mL versus 94 ± 41 mL; P = .003). No surge occurred in the infusion group; it occurred a mean of 3.00 ± 4.16 times in the control group (PGas-forced infusion was safe and effective in controlling surge and increased the safety, ease, and speed of coaxial phacoemulsification. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Clinical applications of corneal confocal microscopy

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Mitra Tavakoli

2008-06-01

Full Text Available Mitra Tavakoli1, Parwez Hossain2, Rayaz A Malik11Division of Cardiovascular Medicine, University of Manchester and Manchester Royal Infirmary, Manchester, UK; 2University of Southampton, Southampton Eye Unit, Southampton General Hospital, Southampton, UKAbstract: Corneal confocal microscopy is a novel clinical technique for the study of corneal cellular structure. It provides images which are comparable to in-vitro histochemical techniques delineating corneal epithelium, Bowman’s layer, stroma, Descemet’s membrane and the corneal endothelium. Because, corneal confocal microscopy is a non invasive technique for in vivo imaging of the living cornea it has huge clinical potential to investigate numerous corneal diseases. Thus far it has been used in the detection and management of pathologic and infectious conditions, corneal dystrophies and ecstasies, monitoring contact lens induced corneal changes and for pre and post surgical evaluation (PRK, LASIK and LASEK, flap evaluations and Radial Keratotomy, and penetrating keratoplasty. Most recently it has been used as a surrogate for peripheral nerve damage in a variety of peripheral neuropathies and may have potential in acting as a surrogate marker for endothelial abnormalities.Keywords: corneal confocal microscopy, cornea, infective keratitis, corneal dystrophy, neuropathy

Neurotrophic corneal and conjunctival xerosis

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Svetlana Gennadyevna Zhurova

2014-03-01

Full Text Available Purpose: to develop a method of surgical treatment of patients with corneal ulcers of xerotic etiology and evaluate its efficacy in different time periods after operation. Materials and methods: 68 patients (86 eyes with severe dry eye syndrome complicated by xerotic corneal ulcers were examined. In all patients, the ulcer defect was covered with conjunctiva and amniotic membrane. The operation was combined with an outer tarsorrhaphy and temporary blepharorraphy. Results: All 86 eyes (100% achieved total closure of the ulcer defect, sealing of any perforation and maintaining of corneal transparency beyond the ulcer defect. Conclusion: Surgical closure of corneal ulcers with conjunctiva is an effective method of treatment of xerotic corneal ulcers. It could be recommended in patients with corneal perforation and tendency of descemetocele formation.

Altered corneal stromal matrix organization is associated with mucopolysaccharidosis I, III and VI.

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Alroy, J; Haskins, M; Birk, D E

1999-05-01

The presence of cloudy corneas is a prominent feature of mucopolysaccharidosis (MPS) types I and VI, but not MPS IIIA or IIIB. The cause of corneal cloudiness in MPS I and VI is speculative. Transparency of the cornea is dependent on the uniform diameter and the regular spacing and arrangement of the collagen fibrils within the stroma. Alterations in the spacing of collagen fibrils in a variety of conditions including corneal edema, scars, and macular corneal dystrophy is clinically manifested as corneal opacity. The purpose of this study was to compare the structural organization of the stromal extracellular matrix of normal corneas with that of MPS corneas. The size and arrangement of collagen fibrils in cloudy corneas from patients with MPS I were examined. The alterations observed were an increased mean fibril diameter with a broader distribution in the MPS corneas. The MPS I corneas also had altered fibril spacing and more irregular packing compared with normal control corneas. The clear corneas of patients with MPS IIIA and IIIB also showed increases in mean fibril diameter and fibril spacing. However, there was less variation indicating more regularity than seen in MPS I. In addition, corneas from cat models of certain MPS were compared to the human corneas. Cats with MPS I and VI, as well as normal control cats, were examined. Structural alterations comparable to those seen in human MPS corneas were seen in MPS I and VI cats relative to normal clear corneas. The findings suggest that cloudy corneas in MPS I and VI are in part a consequence of structural alterations in the corneal stroma, including abnormal spacing, size, and arrangement of collagen fibrils. Copyright 1999 Academic Press.

Inverse cutting of posterior lamellar corneal grafts by a femtosecond laser

DEFF Research Database (Denmark)

Hjortdal, Jesper; Nielsen, Esben; Vestergaard, Anders Højslet

2012-01-01

(range: 1.400 to 2.000 cells per sq. mm). The grafts were of uniform thickness, but substantial interface haze was present in most grafts. Conclusions: Posterior lamellar corneal grafts can be prepared from the endothelial side using a femto-second laser. All grafts were clear after 6 months...

Corneal markers of diabetic neuropathy.

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Pritchard, Nicola; Edwards, Katie; Shahidi, Ayda M; Sampson, Geoff P; Russell, Anthony W; Malik, Rayaz A; Efron, Nathan

2011-01-01

Diabetic neuropathy is a significant clinical problem that currently has no effective therapy, and in advanced cases, leads to foot ulceration and lower limb amputation. The accurate detection, characterization and quantification of this condition are important in order to define at-risk patients, anticipate deterioration, monitor progression, and assess new therapies. This review evaluates novel corneal methods of assessing diabetic neuropathy. Two new noninvasive corneal markers have emerged, and in cross-sectional studies have demonstrated their ability to stratify the severity of this disease. Corneal confocal microscopy allows quantification of corneal nerve parameters and noncontact corneal esthesiometry, the functional correlate of corneal structure, assesses the sensitivity of the cornea. Both these techniques are quick to perform, produce little or no discomfort for the patient, and are suitable for clinical settings. Each has advantages and disadvantages over traditional techniques for assessing diabetic neuropathy. Application of these new corneal markers for longitudinal evaluation of diabetic neuropathy has the potential to reduce dependence on more invasive, costly, and time-consuming assessments, such as skin biopsy.

Topical thrombin-related corneal calcification.

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Kiratli, Hayyam; Irkeç, Murat; Alaçal, Sibel; Söylemezoğlu, Figen

2006-09-01

To report a highly unusual case of corneal calcification after brief intraoperative use of topical thrombin. A 44-year-old man underwent sclerouvectomy for ciliochoroidal leiomyoma, during which 35 UNIH/mL lyophilized bovine thrombin mixed with 9 mL of diluent containing 1500 mmol/mL calcium chloride was used. From the first postoperative day, corneal and anterior lenticular capsule calcifications developed, and corneal involvement slightly enlarged thereafter. A year later, 2 corneal punch biopsies confirmed calcification mainly in the Bowman layer. Topical treatment with 1.5% ethylenediaminetetraacetic acid significantly restored corneal clarity. Six months later, a standard extracapsular cataract extraction with intraocular lens placement improved visual acuity to 20/60. This case suggests that topical thrombin drops with elevated calcium concentrations may cause acute corneal calcification in Bowman layer and on the anterior lens capsule.

Pupil dilation with intracameral lidocaine during phacoemulsification: Benefits for the patient and surgeon

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Nikeghbali Aminollah

2008-01-01

Full Text Available Topical and/or intracameral administration of anticholinergic and/or sympathomimetic mydriatic agents which are usually used for pupillary dilation during cataract surgery, have some disadvantages such as slow onset of dilation and adverse ocular and systemic effects. We evaluated intracameral injection of preservative-free 1% lidocaine without using any preoperative or intraoperative mydriatics to induce pupil dilation in 31 consecutive eyes scheduled for phacoemulsification cataract extraction and intraocular lens implantation. Pupil diameter was measured before and 90 sec after intracameral lidocaine injection. After intracameral lidocaine injection, the mean pupil diameter was significantly greater than the baseline measurement (P< 0.001. No additional mydriatics were needed up to the end of the operations. Intracameral preservative-free lidocaine 1% has a rapid and effective mydriasis that could be a safe alternative to topical and intracameral mydriatics in phacoemulsification.

Corneal Transplantation

DEFF Research Database (Denmark)

Hjortdal, Jesper Østergaard

with less risk of rejection episodes. Besides covering updated chapters on penetrating keratoplasty, and anterior and posterior lamellar procedures, this textbook also gives a thorough overview of the history of corneal transplantation and a detailed presentation of the microstructural components...... and to assist fellows and corneal surgeons in their advice and selection of patients for the best surgical procedure considering benefi ts and risks....

Resolution of persistent corneal erosion after administration of topical rebamipide

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Kashima T

2012-08-01

Full Text Available Tomoyuki Kashima,1,2 Hideo Akiyama,1 Fumihide Miura,2 Shoji Kishi11Department of Ophthalmology, Gunma University School of Medicine, Maebashi, Japan; 2Department of Ophthalmology, Saku Central Hospital, Saku, JapanAbstract: Rebamipide is an antiulcer agent used to treat gastric ulcer and gastritis. Biological effects of rebamipide include cytoprotection, wound healing, and anti-inflammatory properties that are known to be universal for a variety of tissues in addition to gastrointestinal mucosa. The therapeutic effects of rebamipide eye drops are due to its ability to increase corneal and conjunctival mucin-like substances and improve corneal and conjunctival injury in vivo. In this paper, we report a case of Sjögren's syndrome with complete disappearance of corneal erosion after administration of rebamipide eye drops. This was observed even though corneal erosion had not improved for 6 months after punctal occlusion surgery. The patient was a 33-year-old female, diagnosed with Sjögren's syndrome by a salivary gland biopsy. The corneal and conjunctival surfaces were filled with dense erosions, which did not improve with topical drugs. Punctal plugs were applied several times; however, the plugs were repeatedly shed. All four puncta of both eyelids were surgically occluded, and both corneal and conjunctival erosion was clearly improved. However, the erosion in the inferior cornea of both eyes had not improved for 6 months after surgery. We used the newly approved topical rebamipide for treatment of this patient. The corneal erosion gradually improved and completely disappeared 4 weeks after administration of the drug. Dry eye sensation disappeared at the same time. Both membrane-associated mucin and secreted mucin in the ocular surface are thought to be essential for maintenance of the tear film. Induction of mucin from ocular surface epithelium could be an effective treatment in cases of dry eye caused by mucin deficiency. Through its various

Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems.

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Yesilirmak, Nilufer; Diakonis, Vasilios F; Sise, Adam; Waren, Daniel P; Yoo, Sonia H; Donaldson, Kendall E

2017-01-01

To compare the mean cumulative dissipated energy (CDE) in patients having femtosecond laser-assisted or conventional phacoemulsification cataract surgery using 2 different phacoemulsification platforms. Bascom Palmer Eye Institute, Miami, Florida, USA. Prospective comparative nonrandomized clinical study. Consecutive patients were scheduled to have femtosecond laser-assisted cataract surgery with the Lensx laser or conventional phacoemulsification using an active-fluidics torsional platform (Centurion) or torsional platform (Infiniti). The mean CDE and cataract grade were recorded. The study comprised 570 eyes (570 patients). There was no statistically significant difference in mean age (P = .41, femtosecond group; P = .33, conventional group) or cataract grade (P = .78 and P = .45, respectively) between the active-fluidics and gravity-fluidics platforms. In femtosecond cases (145 eyes), the mean CDE (percent-seconds) was 5.18 ± 4.58 (SD) with active fluidics and 7.00 ± 6.85 with gravity fluidics; in conventional cases (425 eyes), the mean CDE was 7.77 ± 6.97 and 11.43 ± 9.12, respectively. In both femtosecond cases and conventional cases, the CDE was lower with the active-fluidics platform than with the gravity-fluidics platform (P = .029, femtosecond group; P < .001 conventional group). With both fluidics platforms, the mean CDE was significantly lower in the femtosecond group than in the conventional group (both P < .001). The active-fluidics phacoemulsification platform achieved lower CDE values than the gravity-fluidics platform for conventional cataract extraction. Femtosecond laser pretreatment with the active-fluidics platform further reduced CDE. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Applications of corneal topography and tomography: a review.

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Fan, Rachel; Chan, Tommy Cy; Prakash, Gaurav; Jhanji, Vishal

2018-03-01

Corneal imaging is essential for diagnosing and management of a wide variety of ocular diseases. Corneal topography is used to characterize the shape of the cornea, specifically, the anterior surface of the cornea. Most corneal topographical systems are based on Placido disc that analyse rings that are reflected off the corneal surface. The posterior corneal surface cannot be characterized using Placido disc technology. Imaging of the posterior corneal surface is useful for diagnosis of corneal ectasia. Unlike corneal topographers, tomographers generate a three-dimensional recreation of the anterior segment and provide information about the corneal thickness. Scheimpflug imaging is one of the most commonly used techniques for corneal tomography. The cross-sectional images generated by a rotating Scheimpflug camera are used to locate the anterior and posterior corneal surfaces. The clinical uses of corneal topography include, diagnosis of corneal ectasia, assessment of corneal astigmatism, and refractive surgery planning. This review will discuss the applications of corneal topography and tomography in clinical practice. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Influence of preoperative artificial tears on tear film after phacoemulsification on dry eye of diabetes patients

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Rui Su

2015-05-01

Full Text Available AIM: To discuss the artificial tears on the tear film of diabetic patients with dry eye preoperatively, and the influence on the tear film's fuctional after phacoemulsification.METHODS: Fifty-four diabetic patients with dry eye(60 eyeswere followed up before phacoemulsification. Preoperatively, group A(30 eyes in 28 caseswas treated with Hydroxyl Indican eye drops and group B(30 eyes in 26 caseswas not treated. Postoperatively, both group A and B were treated with Tobramycin Dexamethasone eye drops, Oprah Winfrey Ibuprofen eye drops and Hydroxyl Indican eye drops. Dry eye symptoms, break up time(BUT, Schirmer Ⅰ test(S Ⅰ t, fluorescein stain test(FIwere measured at 3d preoperatively, and 1, 7, 30, 90d postoperatively.RESULTS: At 3d preoperatively, there was no statistical differences between the two groups for dry eye symptoms, BUT, SⅠt, FI(P>0.05. At 1 and 7d postoperatively, there were significant statistical differents between the two groups for dry eye symptoms(PPP>0.05.CONCLUSION: Using artificial tears before phacoemulsification can improve symptoms of the diabetic patients with dry eye and accelerate the recovery of the tear film.

Management of moderate and severe corneal astigmatism with AcrySof® toric intraocular lens implantation - Our experience.

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Farooqui, Javed Hussain; Koul, Archana; Dutta, Ranjan; Shroff, Noshir Minoo

2015-01-01

Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism. Cataract services, Shroff Eye Centre, New Delhi, India. Case series. This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months. The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was -0.04 (SD = 0.76). We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.

Protective effects of trehalose on the corneal epithelial cells.

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Aragona, Pasquale; Colosi, Pietro; Rania, Laura; Colosi, Francesca; Pisani, Antonina; Puzzolo, Domenico; Micali, Antonio

2014-01-01

Aim of the present work was to evaluate the effects of the trehalose on the corneal epithelium undergoing alcohol delamination. Twelve patients undergoing laser subepithelial keratomileusis (LASEK) were consecutively included in the study. The right eyes were pretreated with 3% trehalose eye drops, whilst left eyes were used as control. Epithelial specimens were processed for cells vitality assessment, apoptosis, and light and transmission electron microscopy; a morphometric analysis was performed in both groups. In both trehalose-untreated eyes (TUE) and trehalose-treated eyes (TTE), the percentage of vital cells was similar and no apoptotic cells were observed. In TUE, the corneal epithelium showed superficial cells with reduced microfolds, wing cells with vesicles and dilated intercellular spaces, and dark basal cells with vesicles and wide clefts. In TTE, superficial and wing cells were better preserved, and basal cells were generally clear with intracytoplasmatic vesicles. The morphometric analysis showed statistically significant differences between the two groups: the TTE epithelial height was higher, the basal cells showed larger area and clearer cytoplasm. The distribution of desmosomes and hemidesmosomes was significantly different between the groups. Trehalose administration better preserved morphological and morphometric features of alcohol-treated corneal epithelium, when compared to controls.

Выбор хирургического метода коррекции индуцированных аметропий после кератотомии

OpenAIRE

Блинкова, Елена; Джаши, Бента

2014-01-01

LASIK technique allows for correction of ametropia induced keratorefractive after surgery. For the correction of ametropia induced on background hyperopic refraction with ectasia and in the absence of progression of corneal changes preferred phacoemulsification with IOL implantation.

Effects of artificial tear treatment on corneal epithelial thickness and corneal topography findings in dry eye patients.

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Çakır, B; Doğan, E; Çelik, E; Babashli, T; Uçak, T; Alagöz, G

2018-05-01

To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. Sixty-one eyes of 33 female dry eye patients (mean age: 38.3±5.7 years) were enrolled. The mean follow-up time was 36.4±3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P=0.000, P=0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment (P=0.001, P=0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Effect of biometric characteristics on biomechanical properties of the cornea in cataract patient.

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Song, Xue-Fei; Langenbucher, Achim; Gatzioufas, Zisis; Seitz, Berthold; El-Husseiny, Moatasem

2016-01-01

To determine the impact of biometric characteristics on the biomechanical properties of the human cornea using the ocular response analyzer (ORA) and standard comprehensive ophthalmic examinations before and after standard phacoemulsification. This study comprised 54 eyes with cataract with significant lens opacification in stages I or II that underwent phacoemulsification (2.8 mm incision). Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured by ORA preoperatively and at 1mo postoperatively. Biometric characteristics were derived from corneal topography [TMS-5, anterior equivalent (EQTMS) and cylindric (CYLTMS) power], corneal tomography [Casia, anterior and posterior equivalent (EQaCASIC, EQpCASIA) and cylindric (CYLaCASIA, CYLpCASIA) power], keratometry [IOLMaster, anterior equivalent (EQIOL) and cylindric (CYLIOL) power] and autorefractor [anterior equivalent (EQAR)]. Results from ORA were analyzed and correlated with those from all other examinations taken at the same time point. Preoperatively, CH correlated with EQpCASIA and CYLpCASIA only (P=0.001, P=0.002). Postoperatively, IOPg and IOPcc correlated with all equivalent powers (EQTMS, EQIOL, EQAR, EQaCASIA and EQpCASIA) (P=0.001, P=0.007, P=0.001, P=0.015, P=0.03 for IOPg and PBiometric characteristics may significantly affect biomechanical properties of the cornea in terms of CH, IOPcc and IOPg before, but even more after cataract surgery.

Topical Drug Formulations for Prolonged Corneal Anesthesia

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Wang, Liqiang; Shankarappa, Sahadev A.; Tong, Rong; Ciolino, Joseph B.; Tsui, Jonathan H.; Chiang, Homer H.; Kohane, Daniel S.

2013-01-01

Purpose Ocular local anesthetics (OLA’s) currently used in routine clinical practice for corneal anesthesia are short acting and their ability to delay corneal healing makes them unsuitable for long-term use. In this study, we examined the effect on the duration of corneal anesthesia of the site-1 sodium channel blocker tetrodotoxin (TTX), applied with either proparacaine or the chemical permeation enhancer OTAB. The effect of test solutions on corneal healing was also studied. Methods Solutions of TTX, proparacaine, and OTAB, singly or in combination were applied topically to the rat cornea. The blink response, an indirect measure of corneal sensitivity, was recorded using a Cochet-Bonnet esthesiometer, and the duration of corneal anesthesia calculated. The effect of test compounds on the rate of corneal epithelialization was studied in vivo following corneal debridement. Results Combination of TTX and proparacaine resulted in corneal anesthesia that was 8–10 times longer in duration than that from either drug administered alone, while OTAB did not prolong anesthesia. The rate of corneal healing was moderately delayed following co-administration of TTX and proparacaine. Conclusion Co-administration of TTX and proparacaine significantly prolonged corneal anesthesia but in view of delayed corneal re-epithelialization, caution is suggested in use of the combination. PMID:23615270

Evaluation of intraocular pressure according to corneal thickness before and after excimer laser corneal ablation for myopia.

Science.gov (United States)

Hamed-Azzam, Shirin; Briscoe, Daniel; Tomkins, Oren; Shehedeh-Mashor, Raneen; Garzozi, Hanna

2013-08-01

Intraocular pressure is affected by corneal thickness and biomechanics. Following ablative corneal refractive surgery, corneal structural changes occur. The purpose of the study is to determine the relationship between the mean central corneal thickness (CCT) and the change in intraocular pressure measurements following various corneal ablation techniques, using different measurement methods. Two hundred myopic eyes undergoing laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) were enrolled into a prospective, non-randomized study. Corneal parameters examined included full ocular examination, measurement of CCT, corneal topography, corneal curvature and ocular refractivity. Intraocular pressure measurements were obtained using three different instruments-non-contact tonometer, Goldmann applanation tonometer and TonoPen XL (TonoPen-Central and TonoPen-Peripheral). All measurements were performed pre-operatively and 4 months post-operatively. Post-operative intraocular pressure was significantly lower than pre-operative values, with all instruments (p value tonometer and non-contact tonometer (p value < 0.001, ANOVA). Intraocular pressure readings are significantly reduced following corneal ablation surgery. We determined in our myopic patient cohort that the TonoPen XL intraocular pressure measurement method is the least affected following PRK and LASIK as compared to other techniques.

Trifluoperazine: corneal endothelial phototoxicity

International Nuclear Information System (INIS)

Hull, D.S.; Csukas, S.; Green, K.

1983-01-01

Trifluoperazine is used for the treatment of psychiatric disorders. Perfusion of corneal endothelial cells with trifluoperazine-HC1 concurrent with exposure to long wavelength ultraviolet light resulted in a corneal swelling rate greater than that found in perfused corneas not exposed to ultraviolet light. Exposure of endothelial cells to 25 W incandescent light during perfusion with trifluoperazine-HC1 did not result in a higher corneal swelling rate compared to those perfused in the dark. The increased corneal swelling rate could be produced by pre-exposure of the trifluoperazine-HC1 perfusing solution to ultraviolet light suggesting the production of toxic photoproducts during exposure of trifluoperazine-HC1 to ultraviolet light. Perfusion of corneal endothelial cells with non-ultraviolet illuminated trifluoperazine-HC1 had no effect on endothelial cell membranes or ultrastructure. This is in contrast to cells perfused with trifluoperazine-HC1 that had been exposed to ultraviolet light in which there was an alteration of mitochondria and a loss of cytoplasmic homogeneity. The data imply that the trifluoperazine-HC1 photoproduct had an adverse effect on cellular transport mechanisms. The study also further demonstrates the value of the corneal endothelial cell model for identifying the physiological and anatomical changes occuring in photo-induced toxic reactions. (author)

Corneal surface temperature change as the mode of stimulation of the non-contact corneal aesthesiometer.

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Murphy, P J; Morgan, P B; Patel, S; Marshall, J

1999-05-01

The non-contact corneal aesthesiometer (NCCA) assesses corneal sensitivity by using a controlled pulse of air, directed at the corneal surface. The purpose of this paper was to investigate whether corneal surface temperature change was a component in the mode of stimulation. Thermocouple experiment: A simple model corneal surface was developed that was composed of a moistened circle of filter paper placed on a thermocouple and mounted on a glass slide. The temperature change produced by different stimulus pressures was measured for five different ambient temperatures. Thermal camera experiment: Using a thermal camera, the corneal surface temperature change was measured in nine young, healthy subjects after exposure to different stimulus air pulses. Pulse duration was set at 0.9 s but was varied in pressure from 0.5 to 3.5 millibars. Thermocouple experiment: An immediate drop in temperature was detected by the thermocouple as soon as the air flow was incident on the filter paper. A greater temperature change was produced by increasing the pressure of the incident air flow. A relationship was found and a calibration curve plotted. Thermal camera experiment: For each subject, a drop in surface temperature was detected at each stimulus pressure. Furthermore, as the stimulus pressure increased, the induced reduction in temperature also increased. A relationship was found and a calibration curve plotted. The NCCA air-pulse stimulus was capable of producing a localized temperature change on the corneal surface. The principal mode of corneal nerve stimulation, by the NCCA air pulse, was the rate of temperature change of the corneal surface.

CONTACT LENS RELATED CORNEAL ULCER

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AGARWAL P

2010-01-01

Full Text Available A corneal ulcer caused by infection is one of the major causes of blindness worldwide. One of the recent health concerns is the increasing incidence of corneal ulcers associated with contact lens user especially if the users fail to follow specific instruction in using their contact lenses. Risk factors associated with increased risk of contact lens related corneal ulcers are:overnight wear, long duration of continuous wear, lower socio-economic classes, smoking, dry eye and poor hygiene. The presenting symptoms of contact lens related corneal ulcers include eye discomfort, foreign body sensation and lacrimation. More serious symptoms are redness (especially circum-corneal injection, severe pain, photophobia, eye discharge and blurring of vision. The diagnosis is established by a thorough slit lamp microscopic examination with fluorescein staining and corneal scraping for Gram stain and culture of the infective organism. Delay in diagnosing and treatment can cause permanent blindness, therefore an early referral to ophthalmologist and commencing of antimicrobial therapy can prevent visual loss.

Clinical efficacy of different artificial tears for patients with xerophthalmia after phacoemulsification

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Bing Wang

2017-12-01

Full Text Available AIM: To compare and analyze the clinical efficacy of different artificial tears for patients with xerophthalmia after phacoemulsification. METHODS: Retrospective analysis on the clinical data of 150 cases(150 eyestreated by phacoemulsification in our hospital from March 2014 to April 2017. And according to the artificial tears used, they were divided into Group A(control groupand B(application of sodium hyaluronate eye drops, Group C(used carbomer gel eye drops,50 cases 50 eyes in every group. We compared and analyzed the BUT, FL, SⅠt findings, OSDI scores preoperatively and 1wk, 1 and 3mo postoperatively, and visual acuity before and 3mo after operation in the three groups. RESULTS: There were no differences in BUT, FL, SⅠt and OSDI scores between the three groups before and at 1wk after the operation(P>0.05. At 1mo after operation, the levels of BUT and SⅠt in Group B and Group C were higher than those in Group A, and the scores of OSDI and FL were lower than those in Group A(PP>0.05. After 3mo, the levels of BUT and SⅠt in the Group B and Group C were higher than that in the Group A, and the FL level and OSDI score were lower than those in the Group A(PPPP>0.05. CONCLUSION: different types of artificial tear can improve the symptoms of dry eyes in patients age-related cataract after phacoemulsification, in which carbomer eye drops or lipid containing artificial tears improve postoperative dry eye symptoms and signs, and will not affect the recovery of visual acuity.

Correlations between corneal and total wavefront aberrations

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Mrochen, Michael; Jankov, Mirko; Bueeler, Michael; Seiler, Theo

2002-06-01

Purpose: Corneal topography data expressed as corneal aberrations are frequently used to report corneal laser surgery results. However, the optical image quality at the retina depends on all optical elements of the eye such as the human lens. Thus, the aim of this study was to investigate the correlations between the corneal and total wavefront aberrations and to discuss the importance of corneal aberrations for representing corneal laser surgery results. Methods: Thirty three eyes of 22 myopic subjects were measured with a corneal topography system and a Tschernig-type wavefront analyzer after the pupils were dilated to at least 6 mm in diameter. All measurements were centered with respect to the line of sight. Corneal and total wavefront aberrations were calculated up to the 6th Zernike order in the same reference plane. Results: Statistically significant correlations (p the corneal and total wavefront aberrations were found for the astigmatism (C3,C5) and all 3rd Zernike order coefficients such as coma (C7,C8). No statistically significant correlations were found for all 4th to 6th order Zernike coefficients except for the 5th order horizontal coma C18 (p equals 0.003). On average, all Zernike coefficients for the corneal aberrations were found to be larger compared to Zernike coefficients for the total wavefront aberrations. Conclusions: Corneal aberrations are only of limited use for representing the optical quality of the human eye after corneal laser surgery. This is due to the lack of correlation between corneal and total wavefront aberrations in most of the higher order aberrations. Besides this, the data present in this study yield towards an aberration balancing between corneal aberrations and the optical elements within the eye that reduces the aberration from the cornea by a certain degree. Consequently, ideal customized ablations have to take both, corneal and total wavefront aberrations, into consideration.

Laser-assisted cataract surgery: benefits and barriers.

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Hatch, Kathryn M; Talamo, Jonathan H

2014-01-01

The use of the femtosecond laser (FSL) in cataract surgery may represent the largest advancement in the field since the inception of phacoemulsification. The goal of this review is to outline the benefits of and barriers to this technology. There are several significant potential benefits of the FSL in cataract surgery over conventional manual cataract surgery: precise capsulotomy formation, clear corneal and limbal relaxing incision construction, lens fragmentation, and lens softening. Evidence suggests that refractive benefits include more precise effective lens position as well as reduced effective phacoemulsification time with the use of FSL compared with manual surgery. Patients with conditions such as Fuchs' endothelial dystrophy, pseudoexfoliation, history of trauma, or brunescent cataracts may particularly benefit from this technology. There are significant financial and logistical issues to consider prior to the purchase of a FSL, including the cost of the laser, and charges to patients, and how the laser affects the patient flow in the operating room. The FSL may significantly change the current approach to cataract surgery.

Combined special capsular tension ring and toric IOL implantation for management of post-DALK high regular astigmatism with subluxated traumatic cataract

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Asim Kumar Kandar

2014-01-01

Full Text Available We report a case of 18-year-old male who has undergone phacoemulsification with implantation of toric IOL (AcrySof IQ SN6AT9 after fixation of lens capsule with Cionni′s capsular tension ring (CTR for subluxated traumatic cataract with high astigmatism after deep anterior lamellar keratoplasty (DALK. He underwent right eye DALK for advanced keratoconus four years earlier. He had history of trauma one year later with displaced clear crystalline lens into  anterior chamber and graft dehiscence, which was repaired successfully. The graft survived, but patient developed cataract with subluxated lens, for which phacoemulsification with implantation of toric IOL was done. Serial  topography showed regular corneal astigmatism of -5.50 diopter (K 1 42.75 D @130°, K 2 48.25 D @40°. At 10-month follow-up, the patient has BCVA 20/30 with + 0.75 DS/- 1.75 DC @ 110°. The capsular bag is quite stable with well-centered IOL. Combination of Cionni′s ring with toric IOL could be a good option to manage such complex cases.

Combined special capsular tension ring and toric IOL implantation for management of post-DALK high regular astigmatism with subluxated traumatic cataract.

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Kandar, Asim Kumar

2014-07-01

We report a case of 18-year-old male who has undergone phacoemulsification with implantation of toric IOL (AcrySof IQ SN6AT9) after fixation of lens capsule with Cionni's capsular tension ring (CTR) for subluxated traumatic cataract with high astigmatism after deep anterior lamellar keratoplasty (DALK). He underwent right eye DALK for advanced keratoconus four years earlier. He had history of trauma one year later with displaced clear crystalline lens into  anterior chamber and graft dehiscence, which was repaired successfully. The graft survived, but patient developed cataract with subluxated lens, for which phacoemulsification with implantation of toric IOL was done. Serial  topography showed regular corneal astigmatism of -5.50 diopter (K 1 42.75 D @130°, K 2 48.25 D @40°). At 10-month follow-up, the patient has BCVA 20/30 with + 0.75 DS/- 1.75 DC @ 110°. The capsular bag is quite stable with well-centered IOL. Combination of Cionni's ring with toric IOL could be a good option to manage such complex cases.

Comparison of the Results of Secondary Anterior Chamber and Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Phacoemulsification Cases

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Nimet Yeşim Erçalık

2014-03-01

Full Text Available Objectives: To compare the visual prognosis and postoperative complication rates of secondary anterior chamber (AC IOL and scleralfixated (SF intraocular lenses (IOL after complicated phacoemulsification surgery. Materials and Methods: Thirty eyes of thirty patients were reviewed for this retrospective study. The patients with secondary AC IOL implantation formed group 1 (n=15, and the patients with secondary SF IOL implantation formed group 2 (n=15. Best-corrected visual acuity (BCVA with Snellen chart, biomicroscopic examination, intraocular pressure (IOP measurement with applanation tonometer, gonioscopy performed by Goldmann’s 3-mirror contact lens, and fundus examination were performed preoperatively in all patients. Results: There was no statistically significant difference in postoperative BCVA (p=0.492 and postoperative success (BCVA not changed or better postoperatively between the 2 groups (p=0.598. Postoperative success rate was 80% in group 1 and 93.7% in Group 2. The postoperative cylindrical power of the eyes did not differ significantly between the groups (p=0.220. The postoperative complications in group 1 were as follows: transient corneal edema in 5 eyes, transient IOP elevation in 2 eyes, postoperative fibrinous reaction in the anterior chamber in one eye, late-onset secondary glaucoma in one eye, hyphema in one eye, cystoid macular edema in one eye, vitreous prolapse into the anterior chamber in one eye, and IOL malposition in one eye. The postoperative complications in group 2 were as follows: transient corneal edema in 3 eyes, vitreous prolapse into the anterior chamber in 2 eyes, IOL malposition in 2 eyes, transient IOP elevation in one eye, and retinal detachment in one eye. Conclusion: In this study, both IOL types were observed to be preferable in cases without adequate capsular support following complicated cataract surgery. However, further studies with large numbers of patients are needed to define the best choice

Corneal Toxicity Following Exposure to Asclepias Tuberosa.

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Mikkelsen, Lauge Hjorth; Hamoudi, Hassan; Gül, Cigdem Altuntas; Heegaard, Steffen

2017-01-01

To present a case of corneal toxicity following exposure to milky plant latex from Asclepias tuberosa. A 70-year-old female presented with blurred vision and pain in her left eye after handling an Ascepias tuberosa . Clinical examination revealed a corneal stromal oedema with small epithelial defects. The corneal endothelium was intact and folds in Descemets membrane were observed. The oedema was treated with chloramphenicol, dexamethasone and scopolamine. The corneal oedema had appeared after corneal exposure to the plant, Asclepias tuberosa , whose latex contains cardenolides that inhibit the Na + / K + -ATPase in the corneal endothelium. The oedema resolved after 96 hours. After nine months the best corrected visual acuity was 20/20. Corneal toxicity has previously been reported for plants of the Asclepias family. This is a rare case describing severe corneal toxicity caused by exposure to latex from Asclepias tuberosa . Handling of plants of the Asclepias family should be kept as a differential diagnosis in cases of acute corneal toxicity.

Distrofia corneal de Schnyder

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Michel Guerra Almaguer

Full Text Available La principal entidad hereditaria con depósitos de lípidos en el estroma corneal es la distrofia cristalina central, conocida como distrofia de Schnyder, quien la describió en Suiza en 1927. Se caracteriza por depósitos blanco-amarillentos en el estroma corneal central y superficial. Se presenta un paciente de 28 años, del sexo masculino y piel negra, con antecedente de salud anterior. Acudió a consulta y refirió una disminución de la visión y cambio de coloración progresiva de ambos ojos, de años de evolución. En la exploración oftalmológica de ambos ojos se apreciaron lesiones blanquecinas anulares a nivel del estroma corneal, con ligera turbidez corneal central. Los estudios refractivos realizados constataron un astigmatismo hipermetrópico simple. El resto del examen oftalmológico fue negativo. Para el diagnóstico de certeza se empleó el microscopio confocal. Se concluye que el caso presenta una distrofia corneal estromal de tipo cristalina, de Schnyder.

Anterior corneal profile with variable asphericity.

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Rosales, Marco A; Juárez-Aubry, Montserrat; López-Olazagasti, Estela; Ibarra, Jorge; Tepichín, Eduardo

2009-12-10

We present a corneal profile in which the eccentricity, e(Q=-e(2)), has a nonlinear continuous variation from the center outwards. This nonlinear variation is intended to fit and reproduce our current experimental data in which the anterior corneal surface of the human eye exhibits different values of e at different diameters. According to our clinical data, the variation is similar to an exponential decay. We propose a linear combination of two exponential functions to describe the variation of e. We then calculate the corneal sagittal height by substituting e in the first-order aspherical surface equation to obtain the corneal profile. This corneal profile will be used as a reference to analyze the resultant profiles of the customized corneal ablation in refractive surgery.

History of corneal transplantation in Australia.

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Coster, Douglas J

2015-04-01

Corneal transplantation is a triumph of modern ophthalmology. The possibility of corneal transplantation was first raised in 1797 but a century passed before Zirm achieved the first successful penetrating graft in 1905. Gibson reported the first corneal graft in Australia from Brisbane in 1940 and English established the first eye bank there a few years later. Corneal transplantation evolved steadily over the twentieth century. In the second half of the century, developments in microsurgery, including surgical materials such as monofilament nylon and strong topical steroid drops, accounted for improvements in outcomes. In 2013, approximately 1500 corneal transplants were done in Australia. Eye banking has evolved to cope with the rising demands for donor corneas. Australian corneal surgeons collaborated to establish and support the Australian Corneal Graft Registry in 1985. It follows the outcomes of their surgery and has become an important international resource for surgeons seeking further improvement with the procedure. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

Phacoemulsification with intraocular lens implantation in primary angle-closure suspect, primary angle-closure and primary angle-closure glaucoma with cataract

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Kun Zeng

2013-08-01

Full Text Available AIM: To evaluate the features and clinical outcomes of cataract extraction by phacoemulsification with intraocular lens implantation in primary angle-closure suspect(PACS, primary angle-closure(PACand primary angle-closure glaucoma(PACGwith cataract.METHODS:Phacoemulsification with intraocular lens implantation was performed on 86 cases(86 eyesdiagnosed as PACS, PAC and PACG co-existing cataract from January to December 2012. All cases were followed up for 3 months to 1 year. Pre-operative and post-operative visual acuity, intraocular pressure(IOP, gonioscopy, ultrasound biomicroscopy(UBM, visual field and usage of anti-glaucomaous eye drops were recorded.RESULTS:Zonular dialysis existed in 19 eyes(22%. The post-operative visual acuity improved in 84 eyes(98%. The post-operative visual acuity was CONCLUSION: PACS, PAC and PACG co-existing zonular dialysis is common. Phacoemulsification with IOL implantation can reduce IOP, deepen anterior chamber and open angle.

Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit

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Chen M

2014-02-01

Full Text Available Ming Chen,1 Kara C LaMattina,2 Thomas Patrianakos,2 Surendar Dwarakanathan2 1Department of Surgery, Division of Ophthalmology, University of Hawaii, Honolulu, HI, USA; 2Division of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, USA Purpose: To compare the complication rate of posterior capsule rupture (PCR with vitreous loss during phacoemulsification at an ambulatory surgical center with published results as a clinical audit for quality control. Methods: A retrospective chart review of 3,339 consecutive patients who underwent routine phacoemulsification by four experienced private practice surgeons from January 1, 2011 to June 30, 2012 at The Surgical Suites, Honolulu, HI, USA. All cases with PCR and vitreous loss were identified and selected for the study. Risk factors of this complication were further examined. Data were sent to John H Stroger Jr Hospital of Cook County, Division of Ophthalmology, for literature review, analysis, and write-up. Results: Twenty-three of the 3,339 cases incurred PCR and vitreous loss during phacoemulsification, for an incidence rate of 0.68%. Miosis, shallow chamber, restlessness, pseudoexfoliation syndrome, floppy iris syndrome, and zonulopathy were the main causes. In addition, surgeon volume (number of cases was inversely correlated with PCR. Conclusion: The rate of PCR with vitreous loss during phacoemulsification in this study may be lower than other published results done at academic centers. However, there was no compatible study available for comparison, as existing studies performed at academic centers included resident cases. This study identified risk factors for PCR/vitreous loss both preoperatively and postoperatively that may assist in application of preventive measures to decrease rates of PCR/vitreous loss. Keywords: phacoemulsification complications, posterior capsule rupture, vitreous loss, vitrectomy, miosis, pseudoexfoliation, floppy iris syndrome, zonulopathy

Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

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Motoko Kawashima

2010-08-01

keratoplasty, the graft remained clear and visual acuity was 20/40.Conclusion: Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.Keywords: vitreoretinal surgery, emergency, foreign body

A Case Report of Severe Corneal Toxicity following 0.5% Topical Moxifloxacin Use

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A.P. Vignesh

2015-02-01

Full Text Available Moxifloxacin is a widely used topical antibiotic in various bacterial infections of the eye. Its safety and efficacy have been proved by many studies. We report a case of a rare adverse effect following its use. A 10-year-old female who had presented with acute bacterial conjunctivitis in both eyes with no corneal involvement was started on preservative-free 0.5% topical moxifloxacin four times a day. The child developed a severe form of corneal toxicity in both eyes with circumcorneal congestion and corneal edema following its use. The child's visual acuity had dropped from 20/20 to 20/400 in both the eyes. Topical moxifloxacin was discontinued, following which the cornea cleared dramatically and the visual acuity became normal. This case indicates that though rare, topical moxifloxacin can cause severe keratitis and that more studies need to be conducted to evaluate its safety.

Glaucoma after corneal replacement.

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Baltaziak, Monika; Chew, Hall F; Podbielski, Dominik W; Ahmed, Iqbal Ike K

Glaucoma is a well-known complication after corneal transplantation surgery. Traditional corneal transplantation surgery, specifically penetrating keratoplasty, has been slowly replaced by the advent of new corneal transplantation procedures: primarily lamellar keratoplasties. There has also been an emergence of keratoprosthesis implants for eyes that are high risk of failure with penetrating keratoplasty. Consequently, there are different rates of glaucoma, pathogenesis, and potential treatment in the form of medical, laser, or surgical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Technique, postoperative complications, and visual outcomes of phacoemulsification cataract surgery in 21 penguins (27 eyes): 2011-2015.

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Church, Melanie L; Priehs, Daniel R; Denis, Heidi; Croft, Lara; DiRocco, Stacy; Davis, Michelle

2018-02-06

To describe surgical technique, postoperative complications, and visual outcome in penguins after phacoemulsification lens extraction surgery. Twenty-one penguins (27 eyes) that had phacoemulsification from 2011 to 2015 at Animal Eye Associates. Species included are as follows: 14 southern Rockhopper (18 eyes, 66.6%), 4 Gentoo (4 eyes, 19%), 2 King (3 eyes, 9.5%), and 1 Chinstrap penguin (2 eyes, 4.8%). Eleven of the penguins were females, and 10 were males with average age at the time of surgery being 27.5 years (range of 22-31 years). This is a retrospective study of phacoemulsification cataract surgery patients from 2011 to 2015. Visual outcome was evaluated by veterinary ophthalmologists at postoperative recheck examinations and subjectively by penguin keepers using individual bird surveys and paired t tests for statistical analysis. All eyes were functionally visual after surgery and at the time of last follow-up. Based on keeper surveys, 81% (17/21) of penguins showed immediate improvements in overall quality of life and 90% (19/21) of penguins exhibited improvement in mobility and behavior within their exhibit following cataract removal. Of the 14 penguins that received 1:5 intracameral atracurium during surgery, 10 (71.4%) had moderate mydriasis, 1 (7.1%) had minimal mydriasis, and 3 (21.4%) showed no effect to the pupil. Seventy percent of the cases had phacoemulsification times less than 60 seconds/eye; the mean time was 72 seconds. Sixteen eyes (59.3%) underwent anterior capsulotomy only, planned anterior and posterior capsulotomies were performed in 3 eyes (11.1%), and the entire lens capsule was removed due to capsular fibrosis and wrinkling in 8 eyes (29.6%). The most common short-term postoperative complication was temporary mild blepharospasm and/or epiphora, reported in 8 eyes (29.6%) from 7 penguins (33.3%). Long-term complications, 2-6 years postoperatively, included posterior synechiation resulting in dyscoria (10 of 24 eyes, 41.7%) and

Analysis of the horizontal corneal diameter, central corneal thickness, and axial length in premature infants

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Ozdemir Ozdemir

2014-08-01

Full Text Available Purpose: To determine the horizontal corneal diameter, central corneal thickness, and axial length in premature infants. Methods: Infants with a birth weight of less than 2,500 g or with a gestation period of less than 36 weeks were included in the study. Infants with retinopathy of prematurity (ROP were allocated to Group 1 (n=138, while those without ROP were allocated to Group 2 (n=236. All infants underwent a complete ophthalmologic examination, including corneal diameter measurements, pachymetry, biometry, and fundoscopy. Between-group comparisons of horizontal corneal diameter, central corneal thickness, and axial lengths were performed. Independent sample t-tests were used for statistical analysis. Results: Data was obtained from 374 eyes of 187 infants (102 female, 85 male. The mean gestational age at birth was 30.7 ± 2.7 weeks (range 25-36 weeks, the mean birth weight was 1,514 ± 533.3 g (range 750-1,970 g, and the mean postmenstrual age at examination was 40.0 ± 4.8 weeks. The mean gestational age and the mean birth weight of Group 1 were statistically lower than Group 2 (p0.05. Conclusions: The presence of ROP in premature infants does not alter the horizontal corneal diameter, central corneal thickness, or axial length.

Corneal Toxicity Following Exposure to Asclepias Tuberosa

DEFF Research Database (Denmark)

Mikkelsen, Lauge Hjorth; Hamoudi, Hassan; Gül, Cigdem Altuntas

2017-01-01

PURPOSE: To present a case of corneal toxicity following exposure to milky plant latex from Asclepias tuberosa. METHODS: A 70-year-old female presented with blurred vision and pain in her left eye after handling an Ascepias tuberosa. Clinical examination revealed a corneal stromal oedema with small...... epithelial defects. The corneal endothelium was intact and folds in Descemets membrane were observed. The oedema was treated with chloramphenicol, dexamethasone and scopolamine. RESULTS: The corneal oedema had appeared after corneal exposure to the plant, Asclepias tuberosa, whose latex contains cardenolides...... that inhibit the Na+/ K+-ATPase in the corneal endothelium. The oedema resolved after 96 hours. After nine months the best corrected visual acuity was 20/20. CONCLUSION: Corneal toxicity has previously been reported for plants of the Asclepias family. This is a rare case describing severe corneal toxicity...

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

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Ming Chen

2015-02-01

Full Text Available AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery (FLACS and traditional phacoemulsification for the first 18mo of FLACS use at a private surgical center in Hawaii. METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined. All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii. RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was 5.8% (PCONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil.

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Aykut, Aslan; Kukner, Amber Senel; Karasu, Bugra; Palancıglu, Yeliz; Atmaca, Fatih; Aydogan, Tumay

2018-01-22

Usage of YouTube as an educational tool is gaining attention in academic research. To date, there has been no study on the content and quality of eye surgery videos on YouTube. The aim of this study was to analyze YouTube videos on phacoemulsification in eyes with small pupil. We searched for the phrases "small pupil cataract surgery," "small pupil phacoemulsification," "small pupil cataract surgery complications," and "small pupil phacoemulsification complications" in January 2015. Each resulting video was evaluated by all authors, and Krippendorff's alpha was calculated to measure agreement. Videos were classified according to pupil size (small/very small) in the beginning of the surgery, and whether pupillary diameter was large enough to continue surgery safely after pupillary dilation by the surgeon in the video (safe/not safe). Methods of dilatation were also analyzed. Any stated ocular comorbidity or surgical complications were noted. A total of 96 videos were reviewed. No mechanical intervention for pupillary dilatation was performed in 46 videos. Fifty-eight operated eyes had no stated ocular comorbidity. Ninety-five operations ended successfully without major complication. There was fair agreement between the evaluators regarding pupil sizes (Kα = 0.670) but poor agreement regarding safety (Kα = 0.337). YouTube videos on small pupil phacoemulsification have low complication rates when compared to the literature, although no reliable mechanical dilatation methods are used in almost half of these videos. Until YouTube's place in e-learning becomes clearer, we suggest that viewers be cautious regarding small pupil phacoemulsification videos on YouTube.

Instillation of Sericin Enhances Corneal Wound Healing through the ERK Pathway in Rat Debrided Corneal Epithelium

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Noriaki Nagai

2018-04-01

Full Text Available Sericin is a major constituent of silk produced by silkworms. We previously found that the instillation of sericin enhanced the proliferation of corneal epithelial cells, and acted to promote corneal wound healing in both normal and diabetic model rats. However, the mechanisms by which sericin promotes the proliferation of corneal cells have not been established. In this study, we investigated the effects of sericin on Akt and ERK activation in a human corneal epithelial cell line (HCE-T cells and rat debrided corneal epithelium. Although Akt phosphorylation was not detected following the treatment of HCE-T cells with sericin, ERK1/2 phosphorylation was enhanced. The growth of HCE-T cells treated with sericin was significantly increased, with the cell growth of sericin-treated HCE-T cells being 1.7-fold higher in comparison with vehicle-treated HCE-T cells. On the other hand, both of an ERK inhibitor U0126 (non-specific specific inhibitor and SCH772984 (specific inhibitor attenuated the enhanced cell growth by sericin, and the growth level in the case of co-treatment with sericin and ERK1/2 inhibitor was similar to that of cells treated with ERK1/2 inhibitor alone. In an in vivo study using rat debrided corneal epithelium, the corneal wound healing rate was enhanced by the instillation of sericin, and this enhancement was also attenuated by the instillation of U0126. In addition, the corneal wound healing rate in rats co-instilled with sericin and U0126 was similar to that following the instillation of U0126 alone. In conclusion, we found that the instillation of sericin enhanced cell proliferation via the activation of the MAPK/ERK pathway, resulting in the promotion of corneal wound healing in rat eyes. These findings provide significant information for designing further studies to develop potent corneal wound-healing drugs.

Macular thickness and volume after uncomplicated phacoemulsification surgery evaluated by optical coherence tomography. A one-year follow-up.

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Kecik, Dariusz; Makowiec-Tabernacka, Marta; Golebiewska, Joanna; Moneta-Wielgos, Joanna; Kasprzak, Jan

2009-01-01

To evaluate changes in the macular thickness and volume using optical coherence tomography in patients after phacoemulsification and intracapsular implantation of a foldable intraocular lens. The study included 82 patients (37 males and 45 females) after phacoemulsification and intracapsular implantaion of the same type of a foldable intraocular lens, without any other eye disease. Phacoemulsification was performed with an INFINITI machine. In all patients, macular thickness and volume were measured with an optical coherence tomograph (Stratus OCT) using the Fast Macular Thickness Map. The OCT evaluation was performed on days 1, 7, 30 and 90 postoperatively. In 58 patients (71%), it was additionally performed at 12 months after surgery and in 52 patients (63%) the macular parameters in the healthy and operated eyes were compared. A statistically significant increase in the minimal retinal thickness was observed on days 30 (p<0.0005) and 90 (p<0.005) postoperatively compared to post-operative day 1. A statistically significant increase in the foveal volume was seen on days 30 (p<0.00005) and 90 (p<0.0005). A statistically significant increase in the volume of the entire macula was found on days 7, 30 and 90 (p<0.00005). Uncomplicated cataract phacoemulsification is followed by increases in the central retinal thickness, foveal volume and volume of the entire macula on days 30 and 90 and at 12 months postoperatively. Further observation of patients is required to confirm whether the macular parameters will return to their values on day 1 postoperatively and if so, when this will occur.

Unusually delayed presentation of persistent Descemet’s membrane tear and detachment after cataract surgery

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Morkin MI

2014-08-01

Full Text Available Melina I Morkin,1,2 Rehan M Hussain,2 Ryan C Young,2 Tracy Ravin,2 Sander R Dubovy,2 Eduardo C Alfonso2 1Department of Ophthalmology, Shiley Eye Center, University of California – San Diego, San Diego, CA, 2Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA Abstract: A 51-year-old male who had undergone phacoemulsification in his left eye 11 months prior presented with complaint of sudden onset of blurred vision in the same eye. Review of his clinical course, slit-lamp exam, pachymetry, and specular endothelial microscopy led to the diagnosis of acute hydrops caused by Descemet’s membrane dehiscence at the site of the incision. He was initially managed with medical treatment and observation. In the subsequent months of follow-up, the corneal edema and the patient’s visual acuity did not improve. Intracameral gas injection was performed 7 months after presentation, but because of persistent corneal edema and nonattached Descemet’s membrane, penetrating keratoplasty was performed. Histopathologic examination confirmed the diagnosis. The patient has had a clear corneal graft since then. Although Descemet’s membrane detachment is a rather common complication after intraocular surgery, its unusually delayed presentation can also occur, and should not be confused with pseudophakic bullous keratopathy. Many mechanisms have been studied for the development of early tears and detachments after cataract surgery, but little is known about late presentations. The authors explore possible causes, and highlight the importance of instructing patients to avoid eye rubbing and any other type of trauma to the cornea after intraocular surgery. Keywords: Descemet’s membrane tear, detachment, cataract surgery, phacoemulsification

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

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Goel, Ruchi; Kamal, Saurabh; Kumar, Sushil; Kishore, Jugal; Malik, K. P. S.; Angmo Bodh, Sonam; Bansal, Smriti; Singh, Madhu

2012-01-01

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS. PMID:22523646

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

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Ruchi Goel

2012-01-01

Full Text Available Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS. Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (=0.16. Both groups, achieved similar best corrected visual acuity (=0.73, although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

Corneal endothelium in xeroderma pigmentosum: clinical specular microscopy study.

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Mohamed, Ashik; Peguda, Rajini; Ramappa, Muralidhar; Ali, Mohammad Javed; Chaurasia, Sunita

2016-06-01

Xeroderma pigmentosum is a condition caused due to a defective DNA repair mechanism when exposed to ultraviolet radiation. Many of the patients with this disorder develop severely oedematous cornea with varying degrees of anterior corneal haze, which necessitates a full-thickness keratoplasty or selective endothelial keratoplasty. Presence of corneal oedema suggests that these patients have a dysfunctional endothelium. The purpose of this study is to evaluate the corneal endothelium in the patients with xeroderma pigmentosum when clinical specular microscopy was feasible. Thirteen patients with classic skin changes of xeroderma pigmentosum were included in the study conducted during January 2010-December 2012. An age-matched group of 13 volunteers were included as controls who were emmetropes without any history of ocular or systemic illness. Corneal endothelium was assessed using specular microscopy from the central clear area of cornea. The mean age of the patients with xeroderma pigmentosum was 16.6±7.2 years and that of the controls was 17.4±6.9 years (p=0.78). The number of analysed cells and endothelial cell density were significantly higher in controls (pxeroderma pigmentosum (p≤0.007). The specular microscopic findings in patients with xeroderma pigmentosum are suggestive of an accelerated endothelial cell loss. It is pertinent that the treating physicians must be involved in emphasising proper ocular protection from ultraviolet radiation to prevent avoidable blindness from xeroderma pigmentosum. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Porcine cadaver iris model for iris heating during corneal surgery with a femtosecond laser

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Sun, Hui; Fan, Zhongwei; Wang, Jiang; Yan, Ying; Juhasz, Tibor; Kurtz, Ron

2015-03-01

Multiple femtosecond lasers have now been cleared for use for ophthalmic surgery, including for creation of corneal flaps in LASIK surgery. Preliminary study indicated that during typical surgical use, laser energy may pass beyond the cornea with potential effects on the iris. As a model for laser exposure of the iris during femtosecond corneal surgery, we simulated the temperature rise in porcine cadaver iris during direct illumination by the femtosecond laser. Additionally, ex-vivo iris heating due to femtosecond laser irradiation was measured with an infrared thermal camera (Fluke corp. Everett, WA) as a validation of the simulation.

Protective Effects of Trehalose on the Corneal Epithelial Cells

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Pasquale Aragona

2014-01-01

Full Text Available Purpose. Aim of the present work was to evaluate the effects of the trehalose on the corneal epithelium undergoing alcohol delamination. Methods. Twelve patients undergoing laser subepithelial keratomileusis (LASEK were consecutively included in the study. The right eyes were pretreated with 3% trehalose eye drops, whilst left eyes were used as control. Epithelial specimens were processed for cells vitality assessment, apoptosis, and light and transmission electron microscopy; a morphometric analysis was performed in both groups. Results. In both trehalose-untreated eyes (TUE and trehalose-treated eyes (TTE, the percentage of vital cells was similar and no apoptotic cells were observed. In TUE, the corneal epithelium showed superficial cells with reduced microfolds, wing cells with vesicles and dilated intercellular spaces, and dark basal cells with vesicles and wide clefts. In TTE, superficial and wing cells were better preserved, and basal cells were generally clear with intracytoplasmatic vesicles. The morphometric analysis showed statistically significant differences between the two groups: the TTE epithelial height was higher, the basal cells showed larger area and clearer cytoplasm. The distribution of desmosomes and hemidesmosomes was significantly different between the groups. Conclusions. Trehalose administration better preserved morphological and morphometric features of alcohol-treated corneal epithelium, when compared to controls.

Human corneal epithelial subpopulations

DEFF Research Database (Denmark)

Søndergaard, Chris Bath

2013-01-01

Corneal epithelium is being regenerated throughout life by limbal epithelial stem cells (LESCs) believed to be located in histologically defined stem cell niches in corneal limbus. Defective or dysfunctional LESCs result in limbal stem cell deficiency (LSCD) causing pain and decreased visual acuity...... subpopulations in human corneal epithelium using a combination of laser capture microdissection and RNA sequencing for global transcriptomic profiling. We compared dissociation cultures, using either expansion on γ-irradiated NIH/3T3 feeder cells in serum-rich medium or expansion directly on plastic in serum...

Corneal collagen crosslinking and pigment dispersion syndrome.

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LaHood, Benjamin R; Moore, Sacha

2017-03-01

We describe the case of a keratoconus patient with pigment dispersion syndrome (PDS) who was treated for progressive corneal ectasia with corneal collagen crosslinking (CXL). Pigment dispersion syndrome has been shown to have associated morphologic changes of the corneal endothelium. Corneal CXL has the potential to cause toxicity to the corneal endothelium, and adjacent pigment might increase the likelihood of damage. In this case, the presence of PDS had no detrimental effect on the outcome of treatment, and no complications were observed at 12 months follow-up, indicating that it may be safe to perform corneal CXL in the setting of PDS. This is an important observation as the number of indications for corneal CXL grows. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

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Yu. A. Pavlova

2014-07-01

Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

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Yu. A. Pavlova

2013-01-01

Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

Corneal melanosis successfully treated using topical mitomycin-C and alcohol corneal epitheliectomy: a 3-year follow-up case report

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Mehmet Balcı

2015-08-01

Full Text Available ABSTRACTWe report a case of primary acquired corneal melanosis without atypia associated with corneal haze in a patient with a history of limbal malignant melanoma and the effect of mitomycin-C. A 75-year-old woman with a history of limbal malignant melanoma presented with loss of vision in right eye. Corneal examination showed a patchy melanotic pigmentation with a central haze. Topical mitomycin-C improved visual acuity and corneal haze. However, the pigmented lesions persisted, and they were removed with alcohol corneal epitheliectomy. Histopathological examination demonstrated primary acquired melanosis without atypia. The lesions were successfully removed, and there were no recurrences during the follow-up period of 36 months. The association of conjunctival and corneal melanosis without atypia is a rare condition. In addition, co-existence of central corneal haze and melanosis may decrease visual acuity. Topical mitomycin-C and alcohol corneal epitheliectomy can be useful treatments in this condition.

Effect of IOP based infusion system with and without balanced phaco tip on cumulative dissipated energy and estimated fluid usage in comparison to gravity fed infusion in torsional phacoemulsification.

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Malik, Praveen K; Dewan, Taru; Patidar, Arun Kr; Sain, Ekta

2017-01-01

To evaluate the effect of three different combinations of tip designs and infusion systems in torsional phacoemulsification (INFINITI and CENTURION) in patients with cataract. According to the manufacturer, two unique improvements in the Centurion are: active fluid dynamic management system and use of an intrepid balanced tip. The study specifically aimed to evaluate the beneficial effects, if any, of change in tip design and infusion system individually and in combination on both per-operative parameters as well as endothelial health over 6 months. One hundred and twenty six consenting patients of grade 4.0-6.9 senile cataract were randomized into three groups for phacoemulsification: Group A ( n  = 42): Gravity fed infusion system and 45 0 Kelman miniflared ABS phaco tip; Group B ( n  = 42): intraocular pressure (IOP) based infusion system and 45 0 Kelman miniflared ABS phaco tip; Group C ( n  = 42): IOP based infusion system and 45 0 Intrepid balanced phaco tip. The cumulative dissipated energy (CDE), estimated fluid usage (EFU) and total aspiration time (TAT) were compared peroperatively. The endothelial parameters were followed up postoperatively for six months. The three arms were matched for age ( p  = 0.525), gender ( p  = 0.96) and grade of cataract ( p  = 0.177). Group C was associated with significant reductions in CDE ( p  = 0.001), EFU ( p  < 0.0005) as well as TAT ( p  = 0.001) in comparison to the other groups. All three groups had comparable baseline endothelial cell density ( p  = 0.876) and central corneal thickness ( p  = 0.561). On post-operative evaluation, although all groups were comparable till 3 months, by 6 months, the percentage losses in endothelial cell density were significantly lower in group C as compared to the other groups. Use of an IOP based phacoemulsification system in association with use of the Intrepid balanced tip reduces the CDE, EFU and TAT in comparison to a gravity fed system with a mini flared

Current status of accelerated corneal cross-linking

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Michael Mrochen

2013-01-01

Full Text Available Corneal cross-linking with riboflavin is a technique to stabilize or reduce corneal ectasia, in diseases such as keratoconus and post-laser-assisted in situ keratomileusis (LASIK ectasia. There is an interest by patient as well as clinicians to reduce the overall treatment time. Especially, the introduction of corneal cross-linking in combination with corneal laser surgery demands a shorter treatment time to assure a sufficient patient flow. The principles and techniques of accelerated corneal cross-linking is discussed.

Corneal Regeneration After Photorefractive Keratectomy: A Review

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Javier Tomás-Juan

2015-07-01

Full Text Available Photorefractive keratectomy (PRK remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain.

Evaluation of subbasal nerve morphology and corneal sensation after accelerated corneal collagen cross-linking treatment on keratoconus.

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Ozgurhan, Engin Bilge; Celik, Ugur; Bozkurt, Ercument; Demirok, Ahmet

2015-05-01

The aim of this study was to report on the evaluation of corneal nerve fiber density and corneal sensation after accelerated corneal collagen cross-linking on keratoconus patients. The study was performed on 30 keratoconus eyes (30 participants: 16 M, 14 F; 17-32 years old) treated with accelerated collagen cross-linking for disease stabilization. Mean outcome measures were corneal sensation evaluation by Cochet-Bonnet esthesiometry and subbasal nerve fiber density assessment by corneal in vivo confocal microscopy. All corneal measurements were performed using scanning slit confocal microscopy (ConfoScan 4, Nidek Technologies, Padova, Italy). The accelerated corneal collagen cross-linking procedure was performed on 30 eyes of 30 patients (19 right, 63.3%; 11 left, 27.7%). The mean age was 23.93 ± 4. The preoperative mean keratometry, apex keratometry and pachymetry values were 47.19 ± 2.82 D, 56.79 ± 5.39 and 426.1 ± 25.6 μm, respectively. Preoperative mean corneal sensation was 56.3 ± 5.4 mm (with a range from 40 to 60 mm), it was significantly decreased at 1st and 3rd month visit and increased to preoperative values after 6th month visit. Preoperative mean of subbasal nerve fiber density measurements was 22.8 ± 9.7 nerve fiber/mm(2) (with a range of 5-45 mm), it was not still at the preoperative values at 6th month (p = 0.0001), however reached to the preoperative values at 12th month (p = 0.914). Subbasal nerve fibers could reach the preoperative values at the 12th month after accelerated corneal collagen cross-linking treatment although the corneal sensation was improved at 6th month. These findings imply that the subjective healing process is faster than the objective evaluation of the keratoconus patients' cornea treated with accelerated corneal collagen cross-linking.

Outcomes of torsional microcoaxial phacoemulsification performed by 12-degree and 22-degree bent tips.

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Helvacioglu, Firat; Yeter, Celal; Tunc, Zeki; Sencan, Sadik

2013-08-01

To compare the safety and efficacy of Ozil Intelligent Phaco torsional microcoaxial phacoemulsification surgeries performed with 12-degree and 22-degree bent tips using the Infiniti Vision System. Maltepe University School of Medicine Department of Ophthalmology, Istanbul, Turkey. Comparative case series. Eyes were assigned to 2.2 mm microcoaxial phacoemulsification using the torsional mode with a 22-degree bent tip (Group 1) or a 12-degree bent tip (Group 2). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound (US) amplitudes, mean surgical time, mean volume of balanced salt solution used, and surgical complications. Both groups included 45 eyes. The mean UST, CDE, longitudinal US amplitude, and torsional US amplitude were 65 seconds ± 27.23 (SD), 11.53 ± 6.99, 0.22 ± 0.26, and 42.86 ± 15.64, respectively, in Group 1 and 84 ± 45.04 seconds, 16.68 ± 10.66, 0.48 ± 0.68, and 46.27 ± 14.74, respectively, in Group 2. The mean UST, CDE, and longitudinal amplitudes were significantly lower in Group 1 (P=.003, P=.008, and P=.022, respectively). The mean volume of balanced salt solution was 73.33 ± 28.58 cc in Group 1 and 82.08 ± 26.21 cc in Group 2 (P=.134). Torsional phacoemulsification performed with 22-degree bent tips provided more effective lens removal than 12-degree bent tips, with a lower UST and CDE. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

In situ ultrahigh-resolution optical coherence tomography characterization of eye bank corneal tissue processed for lamellar keratoplasty.

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Brown, Jamin S; Wang, Danling; Li, Xiaoli; Baluyot, Florence; Iliakis, Bernie; Lindquist, Thomas D; Shirakawa, Rika; Shen, Tueng T; Li, Xingde

2008-08-01

To use optical coherence tomography (OCT) as a noninvasive tool to perform in situ characterization of eye bank corneal tissue processed for lamellar keratoplasty. A custom-built ultrahigh-resolution OCT (UHR-OCT) was used to characterize donor corneal tissue that had been processed for lamellar keratoplasty. Twenty-seven donor corneas were analyzed. Four donor corneas were used as controls, whereas the rest were processed into donor corneal buttons for lamellar transplantation by using hand dissection, a microkeratome, or a femtosecond laser. UHR-OCT was also used to noninvasively characterize and monitor the viable corneal tissue immersed in storage medium over 3 weeks. The UHR-OCT captured high-resolution images of the donor corneal tissue in situ. This noninvasive technique showed the changes in donor corneal tissue morphology with time while in storage medium. The characteristics of the lamellar corneal tissue with each processing modality were clearly visible by UHR-OCT. The in situ characterization of the femtosecond laser-cut corneal tissue was noted to have more interface debris than shown by routine histology. The effects of the femtosecond laser microcavitation bubbles on the corneal tissue were well visualized at the edges of the lamellar flap while in storage medium. The results of our feasibility study show that UHR-OCT can provide superb, in situ microstructural characterization of eye bank corneal tissue noninvasively. The UHR-OCT interface findings and corneal endothelial disc thickness uniformity analysis are valuable information that may be used to optimize the modalities and parameters for lamellar tissue processing. The UHR-OCT is a powerful approach that will allow us to further evaluate the tissue response to different processing techniques for posterior lamellar keratoplasty. It may also provide information that can be used to correlate with postoperative clinical outcomes. UHR-OCT has the potential to become a routine part of tissue

Corneal Reinnervation and Sensation Recovery in Patients With Herpes Zoster Ophthalmicus: An In Vivo and Ex Vivo Study of Corneal Nerves.

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Cruzat, Andrea; Hamrah, Pedram; Cavalcanti, Bernardo M; Zheng, Lixin; Colby, Kathryn; Pavan-Langston, Deborah

2016-05-01

To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO). Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves. The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft. We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.

Inverse cutting of posterior lamellar corneal grafts by a femtosecond laser.

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Hjortdal, Jesper; Nielsen, Esben; Vestergaard, Anders; Søndergaard, Anders

2012-01-01

Posterior lamellar grafting of the cornea has become the preferred technique for treatment of corneal endothelial dysfunction. Posterior lamellar grafts are usually cut by a micro-keratome or a femto-second laser after the epithelial side of the donor cornea has been applanated. This approach often results in variable central graft thickness in different grafts and an increase in graft thickness towards the periphery in every graft. The purpose of this study was to evaluate if posterior lamellar grafts can be prepared from the endothelial side by a femto-second laser, resulting in reproducible, thin grafts of even thickness. A CZM 500 kHz Visumax femto-second laser was used. Organ cultured donor grafts were mounted in an artifical anterior chamber with the endothelial side up and out. Posterior grafts of 7.8 mm diameter and 130 micron thickness were prepared by femto-second laser cutting. A standard DSAEK procedure was performed in 10 patients with Fuchs endothelial dystrophy. Patients were followed-up regularly and evaluated by measurement of complications, visual acuity, corneal thickness (Pentacam HR), and endothelial cell density. Femto-laser cutting of grafts and surgery was uncomplicated. Rebubbling was necessary in 5 of 10 cases (normally only in 1 of 20 cases). All grafts were attached and cleared up during the first few weeks. After six months, the average visual acuity was 0.30 (range: 0.16 to 0.50), corneal thickness was 0.58 mm (range 0.51 to 0.63), and endothelial cell density was 1.570 per sq. mm (range: 1.400 to 2.000 cells per sq. mm). The grafts were of uniform thickness, but substantial interface haze was present in most grafts. Posterior lamellar corneal grafts can be prepared from the endothelial side using a femto-second laser. All grafts were clear after 6 months with satisfying endothelial cell counts. Poor visual acuity caused by interface scatter was observed in most patients. Femto-second laser cutting parameters needs to be optimised to

Corneal Regeneration After Photorefractive Keratectomy: A Review.

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Tomás-Juan, Javier; Murueta-Goyena Larrañaga, Ane; Hanneken, Ludger

2015-01-01

Photorefractive keratectomy (PRK) remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Simultaneous topography-guided PRK followed by corneal collagen cross-linking after lamellar keratoplasty for keratoconus.

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Spadea, Leopoldo; Paroli, Marino

2012-01-01

The purpose of this paper is to report the results of using combined treatment of customized excimer laser-assisted photorefractive keratectomy (PRK) and prophylactic corneal collagen crosslinking (CXL) for residual refractive error in a group of patients who had previously undergone lamellar keratoplasty for keratoconus. The study included 14 eyes from 14 patients who had originally been treated for keratoconus in one eye by excimer laser-assisted lamellar keratoplasty (ELLK), and subsequently presented with residual ametropia (-6.11 D ± 2.48, range -2.50 to -9.50). After a mean 40.1 ± 12.4 months since ELLK they underwent combined simultaneous corneal regularization treatment with topographically guided transepithelial excimer laser PRK (central corneal regularization) and corneal CXL induced by riboflavin-ultraviolet A. After a mean 15 ± 6.5 (range 6-24) months, all eyes gained at least one Snellen line of uncorrected distance visual acuity (range 1-10). No patient lost lines of corrected distance visual acuity, and four patients gained three lines of corrected distance visual acuity. Mean manifest refractive spherical equivalent was -0.79 ± 2.09 (range +1 to -3.0) D, and topographic keratometric astigmatism was 5.02 ± 2.93 (range 0.8-8.9) D. All the corneas remained clear (haze PRK and corneal CXL provided safe and effective results in the management of corneal regularization for refractive purposes after ELLK for keratoconus.

Corneal laceration caused by river crab

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Vinuthinee N

2015-01-01

Full Text Available Naidu Vinuthinee,1,2 Anuar Azreen-Redzal,1 Jaafar Juanarita,1 Embong Zunaina2 1Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, 2Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia Abstract: A 5-year-old boy presented with right eye pain associated with tearing and photophobia of 1-day duration. He gave a history of playing with a river crab when suddenly the crab clamped his fingers. He attempted to fling the crab off, but the crab flew and hit his right eye. Ocular examination revealed a right eye corneal ulcer with clumps of fibrin located beneath the corneal ulcer and 1.6 mm level of hypopyon. At presentation, the Seidel test was negative, with a deep anterior chamber. Culture from the corneal scrapping specimen grew Citrobacter diversus and Proteus vulgaris, and the boy was treated with topical gentamicin and ceftazidime eyedrops. Fibrin clumps beneath the corneal ulcer subsequently dislodged, and revealed a full-thickness corneal laceration wound with a positive Seidel test and shallow anterior chamber. The patient underwent emergency corneal toileting and suturing. Postoperatively, he was treated with oral ciprofloxacin 250 mg 12-hourly for 1 week, topical gentamicin, ceftazidime, and dexamethasone eyedrops for 4 weeks. Right eye vision improved to 6/9 and 6/6 with pinhole at the 2-week follow-up following corneal suture removal. Keywords: corneal ulcer, pediatric trauma, ocular injury

Visual outcome after corneal transplantation for corneal perforation and iris prolapse in 37 horses

DEFF Research Database (Denmark)

Henriksen, Michala de Linde; Plummer, C. E.; Mangan, B.

2012-01-01

We wanted to investigate the visual outcome of horses presented with iris prolapse and treated with corneal transplantation.......We wanted to investigate the visual outcome of horses presented with iris prolapse and treated with corneal transplantation....

Corneal iron ring after conductive keratoplasty.

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Kymionis, George D; Naoumidi, Tatiana L; Aslanides, Ioannis M; Pallikaris, Ioannis G

2003-08-01

To report formation of corneal iron ring deposits after conductive keratoplasty. Observational case report. Case report. A 54-year-old woman underwent conductive keratoplasty for hyperopia. One year after conductive keratoplasty, iron ring pattern pigmentation was detected at the corneal epithelium of both eyes. This is the first report of the appearance of corneal iron ring deposits following conductive keratoplasty treatment in a patient. It is suggested that alterations in tear film stability, resulting from conductive keratoplasty-induced changes in corneal curvature, constitute the contributory factor for these deposits.

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

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Ming Chen

2010-11-01

Full Text Available Ming Chen1, Mindy Chen21University of Hawaii, Honolulu, HI, USA; 2University of California, Irvine, CA, USAAbstract: Mean CDE (cumulative dissipated energy values were compared for an open hospital-based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil was used. Mean CDE values showed that surgeons (individual private practice at the free-standing surgical center were more efficient than surgeons (individual private practice at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]. CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.Keywords: CDE (cumulative dissipated energy, open hospital-based ambulatory surgical center, free-standing surgical center, phacoemulsification 

Explore the full thick layer of corneal transplantation in the treatment of pseudomonas aeruginosa corneal ulcer infection

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Xin Wang

2015-02-01

Full Text Available AIM: To explore the feasibility, safety and effect of the full-thickness lamellar keratoplasty for the treatment of pseudomonas aeruginosa corneal ulcer. METHODS: Based on a retrospective non-controlled study, 25 patients were given the full-thickness lamellar keratoplasty for clinical diagnosis of pseudomonas aeruginosa infection and corneal ulcer medication conventional anti-gram-negative bacteria. Routine follow-up were carried out at postoperative 1wk; 1, 3, 6, 12, 18mo to observe the situation of corneal epithelial healing, recurrent infection, immune rejection, graft transparency and best corrected visual acuity, etc. At the 6 and 12mo postoperative, corneal endothelial cell density was reexamined.RESULTS: No patients because of Descemet's membrane rupture underwent penetrating keratoplasty surgery: One only in cases of bacterial infection after 1mo, once again did not cultivate a culture of bacteria pseudomonas aeruginosa, and the remaining 24 cases average follow-up 14±6mo, corneal graft were transparent, the cure rate was 96%. At the sixth month after surgery, there were 16 cases of eye surgery best corrected visual acuity ≥4.5, of which 3 cases ≥4.8. At the sixth month after surgery, the average corneal endothelial cell density 2 425±278/mm2; At 12mo postoperatively, it was 2 257± 326/mm2.CONCLUSION: Full-thickness lamellar keratoplasty is an effective method of pseudomonas aeruginosa infection in the treatment of corneal ulcers, corneal drying material glycerol can be achieved by visual effects.

Contact Lens Related Corneal Ulcer

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Loh, KY; Agarwal, P

2010-01-01

A corneal ulcer caused by infection is one of the major causes of blindness worldwide. One of the recent health concerns is the increasing incidence of corneal ulcers associated with contact lens user especially if the users fail to follow specific instruction in using their contact lenses. Risk factors associated with increased risk of contact lens related corneal ulcers are: overnight wear, long duration of continuous wear, lower socio-economic classes, smoking, dry eye and poor hygiene. Th...

Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract.

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Akinci, Arsen; Batman, Cosar; Ozkilic, Ersel; Altinsoy, Ali

2009-01-01

The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab injection in patients with diabetic clinically significant macular edema and cataract. The records of 31 patients with diabetic clinically significant macular edema and cataract, which would interfere with macular laser photocoagulation, who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab were retrospectively evaluated. All patients had undergone focal or modified grid laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral optical coherence tomography/optical coherence tomography SLO before and 1 and 3 months after the surgery beyond complete ophthalmologic examination. The best-corrected visual acuity (BCVA) levels and central macular thickness (CMT) recorded at the first and third months after the surgery were compared with the initial values. Paired samples t test was used for statistical analysis. The mean initial BCVA was 0.10 +/- 0.04 (range, 0.05-0.2). The mean BCVA at the first and third months after the surgery were 0.47 +/- 0.16 (standard deviation) (range, 0.2-0.5) and 0.51 +/- 0.12 (standard deviation) (range, 0.3-0.6), respectively. The BCVA level recorded at the first and third months after the surgery were significantly higher than the initial BCVA (P = 0.004). The mean initial CMT was 387.5 +/- 109.5 microm. The mean CMT at the first and third months after the surgery were 292.7 +/- 57.2 and 275.5 +/- 40.3. The CMT recorded at the first and third months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). Phacoemulsification with intravitreal injection of bevacizumab provides improvement in clinically significant macular edema with a gain in BCVA in patients with diabetes with clinically significant macular edema and cataract.

Riboflavin for corneal cross-linking.

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O'Brart, D P S

2016-06-01

Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A (UVA) radiation is the first therapeutic modality that appears to arrest the progression of keratoconus and other corneal ectasias. Riboflavin is central to the process, acting as a photosensitizer for the production of oxygen singlets and riboflavin triplets. These free radicals drive the CXL process within the proteins of the corneal stroma, altering its biomechanical properties. Riboflavin also absorbs the majority of the UVA radiation, which is potentially cytotoxic and mutagenic, within the anterior stroma, preventing damage to internal ocular structures, such as the corneal endothelium, lens and retina. Clinical studies report cessation of ectatic progression in over 90% of cases and the majority document significant improvements in visual, keratometric and topographic parameters. Clinical follow-up is limited to 5-10 years, but suggests sustained stability and enhancement in corneal shape. Sight-threatening complications are rare. The optimal stromal riboflavin dosage for CXL is as yet undetermined. Copyright 2016 Prous Science, S.A.U. or its licensors. All rights reserved.

Management of moderate and severe corneal astigmatism with AcrySof® toric intraocular lens implantation – Our experience

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Farooqui, Javed Hussain; Koul, Archana; Dutta, Ranjan; Shroff, Noshir Minoo

2015-01-01

Purpose Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism. Setting Cataract services, Shroff Eye Centre, New Delhi, India. Design Case series. Method This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months. Results The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees (SD = 2.60) by slit lamp method and 3.88 degrees (SD = 2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD = 0.02), on 7th post-op day was 0.138 (SD = 0.11), and on 30th post-op day was 0.081 (SD = 0.11). The mean log MAR BCVA at three months was −0.04 (SD = 0.76). Conclusion We believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery. PMID:26586976

Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty

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Júlio C. D. Arantes

2017-01-01

Full Text Available Background. To evaluate the change in corneal astigmatism after intrastromal corneal ring segment (ICRS implantation in keratoconus patients with previous deep anterior lamellar keratoplasty (DALK. Design was a longitudinal, retrospective, interventional study. The study included 25 eyes of 24 patients with keratoconus who had DALK performed at least two years prior to ICRS implantation. All patients had a clear corneal graft with up to 8.00 D of corneal astigmatism and intolerance to contact lenses. The studied parameters were age, sex, corrected distance visual acuity (CDVA, maximum keratometry (K1, minimum keratometry (K2, spherical equivalent, and astigmatism. There was a statistically significant decrease in the postintervention analysis as follows: 3.5 D reduction in K1 (p<0.001; 1.53 D in K2 (p=0.005; and 2.52 D (p<0.001 in the average K. The spherical equivalent reduced from −3.67 D (±2.74 to −0.71 D (±2.35 (p<0.001. The topographic astigmatism reduced from 3.87 D preoperatively to 1.90 D postoperatively (p<0.001. The CDVA improved from 0.33 (±0.10 to 0.20 (±0.09, p<0.001. ICRS implantation is a useful option for the correction of astigmatism after DALK as it yields significant visual, topographic, and refractive results.

Chlorpromazine-induced corneal endothelial phototoxicity

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Hull, D.S.; Csukas, S.; Green, K.

1982-01-01

Chlorpromazine, which has been used extensively for the treatment of psychiatric disorders, is known to accumulate in the posterior corneal stroma, lens, and uveal tract. Because it is a phototoxic compound, the potential exists for it to cause cellular damage after light exposure. Specular microscopic perfusion of corneal endothelial cells in darkness with 0.5 mM chlorpromazine HCl resulted in a swelling rate of 18 +/- 2 micrometer/hr, whereas corneas exposed to long-wavelength ultraviolet light for 3 min in the presence of 0.5 mM chlorpromazine swelled at 37 +/- 9 micrometer/hr (p less than 0.01). Preirradiation of 0.5 mM chlorpromazine solution with ultraviolet light for 30 min and subsequent corneal perfusion with the solution resulted in a corneal swelling rate of 45 +/- 19 micrometer/hr. Cornea endothelial cells perfused with 0.5 mM chlorpromazine that was preirradiated with ultraviolet light showed marked swelling on scanning electron microscopic examination, whereas those perfused with nonirradiated chlorpromazine were flat and showed a normal mosaic pattern. Combining either 500 U/ml catalase or 290 U/ml superoxide dismutase with chlorpromazine did not alter photoinduction of corneal swelling. The data suggest that corneal endothelial chlorpromazine phototoxicity is secondary to cytotoxic products resulting from the photodynamically induced decomposition of chlorpromazine and is not caused by hydrogen peroxide or superoxide anion generated during the phototoxic reaction

Corneal Neurotoxicity Due to Topical Benzalkonium Chloride

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Sarkar, Joy; Chaudhary, Shweta; Namavari, Abed; Ozturk, Okan; Chang, Jin-Hong; Yco, Lisette; Sonawane, Snehal; Khanolkar, Vishakha; Hallak, Joelle; Jain, Sandeep

2012-01-01

Topical application of benzalkonium chloride (BAK) to the eye causes dose-related corneal neurotoxicity. Corneal inflammation and reduction in aqueous tear production accompany neurotoxicity. Cessation of BAK treatment leads to recovery of corneal nerve density.

Long-term outcomes of wedge resection at the limbus for high irregular corneal astigmatism after repaired corneal laceration

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Jun Du

2016-06-01

Full Text Available AIM: To evaluate the clinical value of wedge resection at corneal limbus in patients with traumatic corneal scarring and high irregular astigmatism. METHODS: Patients with traumatic corneal astigmatism received wedge resection at least 6mo after suture removal from corneal wound. The uncorrected distance visual acuities (UCVA and best corrected distance visual acuities (BCVA, pre- and post-operation astigmatism, spherical equivalent (SE, safety and complications were evaluated. RESULTS: Ten eyes (10 patients were enrolled in this study. Mean follow-up time after wedge resection was 37.8±15.4mo (range, 20-61mo. The mean UCVA improved from +1.07±0.55 logMAR to +0.43±0.22 logMAR (P=0.000 and the mean BCVA from +0.50±0.30 logMAR to +0.15±0.17 logMAR (P=0.000. The mean astigmatism power measured by retinoscopy was -2.03±2.27 D postoperatively and -2.83±4.52 D preoperatively (P=0.310. The mean SE was -0.74±1.61 D postoperatively and -0.64±1.89 D preoperatively (P=0.601. Two cases developed mild pannus near the sutures. No corneal perforation, infectious keratitis or wound gape occurred. CONCLUSION: Corneal-scleral limbal wedge resection with compression suture is a safe, effective treatment for poor patients with high irregular corneal astigmatism after corneal-scleral penetrating injury. Retinoscopy can prove particularly useful for high irregular corneal astigmatism when other measurements are not amenable.

Combined 30-degree bevel up and down technique against 0-degree phaco tip for phacoemulsification surgery of hard cataracts

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Joshi RS

2017-06-01

Full Text Available Rajesh Subhash Joshi, Sonal Jayant Muley Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India Purpose: To evaluate the effective phaco time (EPT, cumulative dissipated energy (CDE and nucleus emulsification time (NET as phaco parameters with 0- and 30-degree phaco tip. Patients and methods: This prospective, interventional and observational case series included 294 patients scheduled for cataract removal by phacoemulsification technique. Patients with nuclear cataracts of grade 4 and 5 nuclear opalescence of Lens Opacities Classification System III were included in the study. Patients were consecutively allocated to phaco chop technique with 0-degree (0-degree group, n=147 and combined bevel up and down position using 30-degree phaco tip (combined bevel up/down group, n=147. The 0-degree group had phacoemulsification with 0-degree phaco tip, while the 30-degree group had chopping of the nucleus with bevel down phaco tip and emulsification of nuclear fragments was accomplished with bevel up tip. EPT, CDE, NET and intraoperative complications were noted and compared between the groups using analysis of variance. Results: Average EPT, CDE and NET were lower in the 30-degree group than in the 0-degree group. However, no statistically significant difference was found in EPT (P=0.0733, CDE (P=0.0663 and NET (P=0.0633 between the two groups. No serious intraoperative complications were noted. The anterior chamber was maintained throughout the procedure in both groups. No patients had wound burn and miosis during the procedure. None of the patients developed bullous keratopathy, uveitis and cystoid macular edema during the follow-up period. Conclusion: Combined bevel up and down 30-degree tip can yield effective hard nucleus phacoemulsification. Bevel down tip of 30-degree helps in effective chopping and bevel up tip assists in emulsification of the nuclear fragments. Although combined bevel up and down 30

Patients with Fuchs Endothelial Dystrophy and Cataract Undergoing Descemet Stripping Automated Endothelial Keratoplasty and Phacoemulsification with Intraocular Lens Implant: Staged versus Combined Procedure Outcomes.

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Sykakis, Evripidis; Lam, Fook Chang; Georgoudis, Panagiotis; Hamada, Samer; Lake, Damian

2015-01-01

Purpose. To compare the surgical outcomes of staged and combined phacoemulsification with intraocular lens implant (phaco+IOL) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs' endothelial dystrophy and cataract. Setting. Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK. Methods. Retrospective study of patients who had combined phaco+IOL and DSAEK (group 1) or phaco+IOL followed within 2 months by DSAEK (group 2). Patients who had previous eye surgery or any other ocular comorbidities were excluded. Results. There were 28 eyes in group 1 and 31 in group 2. There were no significant differences in the demographics and corneal tissue characteristics of the two groups. The endothelial disc dislocation and rebubbling rate within 1 week in group 1 was 21.42% and in group 2 was 3.2% (P = 0.04), while the endothelial cell density at 12 months was 1510 ± 433 for group 1 and 1535 ± 482 for group 2 (P = 0.89). The mean 12-month logMAR visual acuity was 0.28 ± 0.24 for group 1 and 0.33 ± 0.15 for group 2 (P = 0.38). Conclusions. Although the combined procedure seems to be associated with a higher complication rate the final outcomes seem to be similar to both methods.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits

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Marcello Colombo-Barboza

2014-10-01

Full Text Available Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05 (day 15: p=0.008 and day 30: p=0.008 and the extent of the corneal injury (opacity lesion was also smaller (day 30: p=0.021. Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns.

Construction of Anterior Hemi-Corneal Equivalents Using Nontransfected Human Corneal Cells and Transplantation in Dog Models.

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Xu, Bin; Song, Zhan; Fan, Tingjun

2017-11-01

Tissue-engineered human anterior hemi-cornea (TE-aHC) is a promising equivalent for treating anterior lamellar keratopathy to surmount the severe shortage of donated corneas. This study was intended to construct a functional TE-aHC with nontransfected human corneal stromal (ntHCS) and epithelial (ntHCEP) cells using acellular porcine corneal stromata (aPCS) as a carrier scaffold, and evaluate its biological functions in a dog model. To construct a TE-aHC, ntHCS cells were injected into an aPCS scaffold and cultured for 3 days; then, ntHCEP cells were inoculated onto the Bowman's membrane of the scaffold and cultured for 5 days under air-liquid interface condition. After its morphology and histological structure were characterized, the constructed TE-aHC was transplanted into dog eyes via lamellar keratoplasty. The corneal transparency, thickness, intraocular pressure, epithelial integrity, and corneal regeneration were monitored in vivo, and the histological structure and histochemical property were examined ex vivo 360 days after surgery, respectively. The results showed that the constructed TE-aHC was highly transparent and composed of a corneal epithelium of 7-8 layer ntHCEP cells and a corneal stroma of regularly aligned collagen fibers and well-preserved glycosaminoglycans with sparsely distributed ntHCS cells, mimicking a normal anterior hemi-cornea (aHC). Moreover, both ntHCEP and ntHCS cells maintained positive expression of their marker and functional proteins. After transplantation into dog eyes, the constructed TE-aHC acted naturally in terms of morphology, structure and inherent property, and functioned well in maintaining corneal clarity, thickness, normal histological structure, and composition in dog models by reconstructing a normal aHC, which could be used as a promising aHC equivalent in corneal regenerative medicine and aHC disorder therapy. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Corneal Toxicity Following Exposure to Asclepias Tuberosa

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Mikkelsen, Lauge Hjorth; Hamoudi, Hassan; G?l, Cigdem Altuntas; Heegaard, Steffen

2017-01-01

PURPOSE: To present a case of corneal toxicity following exposure to milky plant latex from Asclepias tuberosa.METHODS: A 70-year-old female presented with blurred vision and pain in her left eye after handling an Ascepias tuberosa. Clinical examination revealed a corneal stromal oedema with small epithelial defects. The corneal endothelium was intact and folds in Descemets membrane were observed. The oedema was treated with chloramphenicol, dexamethasone and scopolamine.RESULTS: The corneal ...

Corneal hydrops induced by Bell’s paralysis in a case of corneal ectasia

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Lokman Aslan

2017-09-01

Full Text Available An 18-year-old male patient presented with suddenly decreased vision, itching, corneal edema and an inability to close the left eye. They had left Bell’s paralysis for two weeks and had used high diopter glasses for five years. The best corrected visual acuity was 0.4 in their right eye and counting fingers in the left eye. Biomicroscopic examination revealed thinning and steepening of the cornea in the right eye and anterior protrusion of the cornea, stromal edema and punctate disruption of the epithelium in the left eye. Topographic image of the right eye was consistent with keratoconus. Six months later, stromal edema gradually regressed and a corneal scar ensued. This case presentation emphasizes that Bell’s palsy may induce disease progression in a patient with preexisting corneal ectasia and results in corneal hydrops. [Arch Clin Exp Surg 2017; 6(3.000: 165-167

Combined phacocanaloplasty for open-angle glaucoma and cataract: 12 months results

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Genaidy MM

2017-12-01

Full Text Available Mahmoud Mohamed Genaidy, Hosny Ahmed Zein, Ahmed Mostafa Eid Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt Purpose of the study: To evaluate efficacy, safety, and success rates of canaloplasty combined with phacoemulsification and intraocular lens implantation in patients with open-angle glaucoma (OAG and visually significant cataract.Patients and methods: A prospective interventional noncomparative case series carried out in Minia University Hospital from April 2015 to October 2016 on 20 eyes of 18 patients who had visually significant cataract and primary OAG. All the cases had combined phacocanaloplasty. Preoperative best-corrected visual acuity, intraocular pressure (IOP, and number of antiglaucoma medications were collected and compared to postoperative levels, and complications rates were recorded.Results: 20 eyes of 18 patients (5 males and 15 females, with a mean age 57.6 years (range 48–69 years, underwent phacocanaloplasty. Preoperative mean IOP was 25.20 ±1.009 mmHg. Postoperative IOP decreased to a mean of 14.20±0.9, 14.85±0.8, and 15.85±0.7 mmHG at 3, 6, and 12 months, respectively, with 37% reduction from preoperative IOP level at one year follow-up visit (P=0.0005. The number of antiglaucoma medications dropped from mean of 1.55 preoperatively to 0.35 postoperatively. LogMAR of best-corrected visual acuity improved from 0.6950±0.07 preoperatively to 0.3670±0.056, 0.3460±0.056, and 0.03370±0.052 at 3, 6, and 12 months postoperatively (P=0.0005. Complications were limited to mild hyphemia (one case, mild corneal edema (one case, and mild inflammatory membrane (one case that resolved in the first week after surgery.Conclusion: Canaloplasty combined with clear corneal phacoemulsification and intraocular lens implantation may be a safe and effective procedure to lower IOP in adult patients with OAG and visually significant cataract. Keywords: cataract, glaucoma, phacoemulsification

Corneal modeling for analysis of photorefractive keratectomy

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Della Vecchia, Michael A.; Lamkin-Kennard, Kathleen

1997-05-01

Procedurally, excimer photorefractive keratectomy is based on the refractive correction of composite spherical and cylindrical ophthalmic errors of the entire eye. These refractive errors are inputted for correction at the corneal plane and for the properly controlled duration and location of laser energy. Topography is usually taken to correspondingly monitor spherical and cylindrical corneorefractive errors. While a corneal topographer provides surface morphologic information, the keratorefractive photoablation is based on the patient's spherical and cylindrical spectacle correction. Topography is at present not directly part of the procedural deterministic parameters. Examination of how corneal curvature at each of the keratometric reference loci affect the shape of the resultant corneal photoablated surface may enhance the accuracy of the desired correction. The objective of this study was to develop a methodology to utilize corneal topography for construction of models depicting pre- and post-operative keratomorphology for analysis of photorefractive keratectomy. Multiple types of models were developed then recreated in optical design software for examination of focal lengths and other optical characteristics. The corneal models were developed using data extracted from the TMS I corneal modeling system (Computed Anatomy, New York, NY). The TMS I does not allow for manipulation of data or differentiation of pre- and post-operative surfaces within its platform, thus models needed to be created for analysis. The data were imported into Matlab where 3D models, surface meshes, and contour plots were created. The data used to generate the models were pre- and post-operative curvatures, heights from the corneal apes, and x-y positions at 6400 locations on the corneal surface. Outlying non-contributory points were eliminated through statistical operations. Pre- and post- operative models were analyzed to obtain the resultant changes in the corneal surfaces during PRK

Late onset corneal ectasia after LASIK surgery.

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Said, Ashraf; Hamade, Issam H; Tabbara, Khalid F

2011-07-01

To report late onset corneal ectasia following myopic LASIK. A retrospective cohort case series. Nineteen patients with late onset corneal ectasia following LASIK procedure were examined at The Eye Center, Riyadh, Saudi Arabia. Patients underwent LASIK for myopia with spherical equivalent ranging from -1.4 to -13.75 diopters. Age and gender, history of systemic or local diseases, and time of onset of corneal ectasia were recorded. Eye examination and corneal topographical analyses were done before and after LASIK surgery. Nineteen patients (29 eyes) with late onset corneal ectasia were identified from 1998 to 2008 in 13 male and six female patients. The mean follow-up period was 108 ± 23 months (range 72-144 months). No patient had pre-operative identifiable risk factors for corneal ectasia and the mean time of onset was 57 ± 24 months (range 24-120 months after LASIK). The pre-operative values included mean central pachymetry 553 ± 25 μm, mean keratometry reading of 42.9 ± 1.5 diopters, average oblique cylinder of 1.4 ± 1.2 diopters, posterior surface elevation of 26 ± 2.1 diopters, corneal flap thickness of 160 μm, mean spherical equivalent of -5.6 ± 3.6 diopters, and calculated residual corneal stromal bed thickness was 288 ± 35 μm. Three (5 eyes) patients developed ectasia after pregnancy. Three (4 eyes) patients developed corneal ectasia following severe adenoviral keratoconjunctivitis and had positive PCR for adenovirus type 8. Corneal ectasia may develop many years after LASIK surgery and symptoms could go undetected for some time. Pregnancy and adenoviral keratoconjunctivitis occurred post-operatively in six patients.

Designing Hydrogel Adhesives for Corneal Wound Repair

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Grinstaff, Mark W.

2013-01-01

Today, corneal wounds are repaired using nylon sutures. Yet there are a number of complications associated with suturing the cornea, and thus there is interest in an adhesive to replace or supplement sutures in the repair of corneal wounds. We are designing and evaluating corneal adhesives prepared from dendrimers – single molecular weight, highly branched polymers. We have explored two strategies to form these ocular adhesives. The first involves a photocrosslinking reaction and the second uses a peptide ligation reactions to couple the individual dendrimers together to from the adhesive. These adhesives were successfully used to repair corneal perforations, close the flap produced in a LASIK procedure, and secure a corneal transplant. PMID:17889330

Granular corneal dystrophy Groenouw type I (GrI) and Reis-Bücklers' corneal dystrophy (R-B). One entity?

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Møller, H U

1989-12-01

This paper maintains that Reis-Bücklers' corneal dystrophy and granular corneal dystrophy Groenouw type I are one and the same disease. Included are some of the technically best photographs of Reis-Bücklers' dystrophy found in the literature, and these are compared with photographs from patients with granular corneal dystrophy examined by the author. It is argued that most of the histological and ultrastructural findings on Reis Bücklers' dystrophy described in the literature are either congruent with what is found in granular corneal dystrophy or unspecific.

Simultaneous topography-guided PRK followed by corneal collagen cross-linking after lamellar keratoplasty for keratoconus

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Spadea L

2012-11-01

Full Text Available Leopoldo Spadea,1 Marino Paroli21University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences, Eye Clinic, L’Aquila, 2La Sapienza University, Department of Biotechnology and Medical-Surgical Sciences, Latina, ItalyBackground: The purpose of this paper is to report the results of using combined treatment of customized excimer laser-assisted photorefractive keratectomy (PRK and prophylactic corneal collagen crosslinking (CXL for residual refractive error in a group of patients who had previously undergone lamellar keratoplasty for keratoconus.Methods: The study included 14 eyes from 14 patients who had originally been treated for keratoconus in one eye by excimer laser-assisted lamellar keratoplasty (ELLK, and subsequently presented with residual ametropia (-6.11 D ± 2.48, range -2.50 to -9.50. After a mean 40.1 ± 12.4 months since ELLK they underwent combined simultaneous corneal regularization treatment with topographically guided transepithelial excimer laser PRK (central corneal regularization and corneal CXL induced by riboflavin-ultraviolet A.Results: After a mean 15 ± 6.5 (range 6–24 months, all eyes gained at least one Snellen line of uncorrected distance visual acuity (range 1–10. No patient lost lines of corrected distance visual acuity, and four patients gained three lines of corrected distance visual acuity. Mean manifest refractive spherical equivalent was -0.79 ± 2.09 (range +1 to -3.0 D, and topographic keratometric astigmatism was 5.02 ± 2.93 (range 0.8–8.9 D. All the corneas remained clear (haze < 1.Conclusion: The combination of customized PRK and corneal CXL provided safe and effective results in the management of corneal regularization for refractive purposes after ELLK for keratoconus.Keywords: corneal collagen crosslinking, excimer laser-assisted lamellar keratoplasty, photorefractive keratectomy

Effects of pranoprofen eye drops on corneal endothelium and tears inflammatory factors in perioperative period of cataract

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Rong-Rong Wang

2018-01-01

Full Text Available AIM: To observe the effect of pranoprofen eye drops on corneal endothelium and tears inflammatory factors in perioperative period of cataract surgery. METHODS: Totally 60 cases(60 eyesof senile cataract patients were enrolled in this study. Patients with diabetes or other systemic diseases, with other eye diseases or eye surgery, drug allergy were excluded. All the patients were given ophthalmic surgery for the first time. All the patients were randomly divided into 4 groups, 15 patients per group. Each group of patients had been given levofloxacin eye drops preoperatively for 3d, 4 times per day, and tobramycin dexamethasone eye drops postoperatively, 3 times per day for the first week, 2 times per day for the second week. Group A was the control group, without any other drugs. Group B was given pranoprofen eye drops 4 times per day for 3d before the operation. Group C was given pranoprofen eye drops 4 times per day for 1wk after the operation. Group D was given pranoprofen eye drops 4 times per day for 3d before the operation and 1wk after the operation. All the surgeries were done by the same ophthalmologist, using the same phacoemulsification machine and the same ultrasound energy parameters. The loss rate of endothelial cell was measured by corneal endothelium counterometry. Interleukin-6(IL-6and tumor necrosis factor(TNFin the tear fluid were measured by ELISA before surgery(before using eye dropsand 1wk, 1mo and 3mo postoperatively. RESULTS: There was no significant difference in patients' gender, age and phacoemulsification time among 4 groups. The levels of inflammatory cytokines IL-6 in the tear fluid of the Group B before surgery had no significant difference compared to that at 3mo postoperatively(P>0.05, but the differences among the other groups at different time points were statistically significant(PP>0.05. At 1wk after the operation, there was significant difference between the Group A and the other three groups(PPP>0.05. At 1mo

Using corneal confocal microscopy to track changes in the corneal layers of dry eye patients after autologous serum treatment.

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Mahelkova, Gabriela; Jirsova, Katerina; Seidler Stangova, Petra; Palos, Michalis; Vesela, Viera; Fales, Ivan; Jiraskova, Nada; Dotrelova, Dagmar

2017-05-01

In vivo corneal confocal microscopy allows the examination of each layer of the cornea in detail and the identification of pathological changes at the cellular level. The purpose of this study was to identify the possible effects of a three-month treatment with autologous serum eye-drops in different corneal layers of patients with severe dry eye disease using corneal confocal microscopy. Twenty-six patients with dry eye disease were included in the study. Corneal fluorescein staining was performed. The corneas of the right eyes were examined using in vivo corneal confocal microscopy before and after a three-month treatment with autologous serum drops. The densities of superficial and basal epithelial cells, Langerhans cells, the keratocytes and activated keratocytes, the density of endothelial cells and the status of the sub-basal nerve plexus fibres were evaluated. A significant decrease in corneal fluorescein staining was found after the three-month autologous serum treatment (p = 0.0006). The basal epithelial cell density decreased significantly (p = 0.001), while the density of superficial epithelial cells did not change significantly (p = 0.473) nor did the number of Langerhans cells or activated keratocytes (p = 0.223; p = 0.307, respectively). There were no differences in the other corneal cell layers or in the status of the nerve fibres. The results demonstrate the ability of corneal confocal microscopy to evaluate an improvement in the basal epithelial cell layer of the cornea after autologous serum treatment in patients with dry eye disease. More studies with longer follow-up periods are needed to elucidate the suitability of corneal confocal microscopy to follow the effect of autologous serum treatment on nerve fibres or other corneal layers in dry eye disease patients. © 2016 Optometry Australia.

Clinical observation of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis

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Huang Zhang

2014-09-01

Full Text Available AIM:To evaluate the clinical efficacy of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis.METHODS:Totally 22 cases(22 eyeswith superficial fungal keratitis were referred to our hospital from April 2012 to October 2013. The patients with persistent cornea ulcer after treatment of local and systemic antifungal drugs underwent corneal lamellar debridement combined with sutureless amniotic membrane transplantation, and the recipient bed was covered with an amniotic membrane using fibrin sealant during the operation. All patients were still given topical antifungal therapy for 1-2mo after operation. The followed-up time was 3mo or above. We observed the corneal healing and amniotic membrane adhesion by split lamp microscope, and investigated the transformation of amniotic membrane and fungal infection recurrence with confocal microscope. RESULTS: Corneal edema and anterior chamber reaction of 21 patients disappeared gradually, and no amniotic membrane graft dissolved and shed off within 1-2wk postoperatively. Two weeks after operation, the graft integrated into the corneal and the corneal wounds' thickness increased gradually, the corneal epithelium reconstructed and corneas became clear. Four weeks after operation, the corneal scarring developed gradually and fluorescence staining was negative. Nineteen cases' amniotic membranes that adhered with the cornea dissolved 4wk after operation. There were different degrees of corneal nebula or macula remained 3mo postoperatively. All patients' vision improved in varying degrees, except in 1 case with fungal keratitis who had been cured by lamellar keratoplasty.CONCLUSION:Corneal lamellar debridement combined with sutureless amniotic membrane transplantation can effectively remove the foci of inflammation, improve the local efficacy, shorten the operation time, relieve the postoperative reaction, and promote cornea

Anatomical characterization of central, apical and minimal corneal thickness

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Federico Saenz-Frances

2014-08-01

Full Text Available AIM: To anatomically locate the points of minimum corneal thickness and central corneal thickness (pupil center in relation to the corneal apex.METHODS: Observational, cross-sectional study, 299 healthy volunteers. Thickness at the corneal apex (AT, minimum corneal thickness (MT and corneal thickness at the pupil center (PT were determined using the pentacam. Distances from the corneal apex to MT (MD and PT (PD were calculated and their quadrant position (taking the corneal apex as the reference determined:point of minimum thickness (MC and point of central thickness (PC depending on the quadrant position. Two multivariate linear regression models were constructed to examine the influence of age, gender, power of the flattest and steepest corneal axes, position of the flattest axis, corneal volume (determined using the Pentacam and PT on MD and PD. The effects of these variables on MC and PC were also determined in two multinomial regression models.RESULTS: MT was located at a mean distance of 0.909 mm from the apex (79.4% in the inferior-temporal quadrant. PT was located at a mean distance of 0.156 mm from the apex. The linear regression model for MD indicated it was significantly influenced by corneal volume (B=-0.024; 95%CI:-0.043 to -0.004. No significant relations were identified in the linear regression model for PD or the multinomial logistic regressions for MC and PC.CONCLUSION: MT was typically located at the inferior-temporal quadrant of the cornea and its distance to the corneal apex tended to decrease with the increment of corneal volume.

Progress in corneal wound healing

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Ljubimov, Alexander V.; Saghizadeh, Mehrnoosh

2015-01-01

Corneal wound healing is a complex process involving cell death, migration, proliferation, differentiation, and extracellular matrix remodeling. Many similarities are observed in the healing processes of corneal epithelial, stromal and endothelial cells, as well as cell-specific differences. Corneal epithelial healing largely depends on limbal stem cells and remodeling of the basement membrane. During stromal healing, keratocytes get transformed to motile and contractile myofibroblasts largely due to activation of transforming growth factor-β system. Endothelial cells heal mostly by migration and spreading, with cell proliferation playing a secondary role. In the last decade, many aspects of wound healing process in different parts of the cornea have been elucidated, and some new therapeutic approaches have emerged. The concept of limbal stem cells received rigorous experimental corroboration, with new markers uncovered and new treatment options including gene and microRNA therapy tested in experimental systems. Transplantation of limbal stem cell-enriched cultures for efficient re-epithelialization in stem cell deficiency and corneal injuries has become reality in clinical setting. Mediators and course of events during stromal healing have been detailed, and new treatment regimens including gene (decorin) and stem cell therapy for excessive healing have been designed. This is a very important advance given the popularity of various refractive surgeries entailing stromal wound healing. Successful surgical ways of replacing the diseased endothelium have been clinically tested, and new approaches to accelerate endothelial healing and suppress endothelial-mesenchymal transformation have been proposed including Rho kinase (ROCK) inhibitor eye drops and gene therapy to activate TGF-β inhibitor SMAD7. Promising new technologies with potential for corneal wound healing manipulation including microRNA, induced pluripotent stem cells to generate corneal epithelium, and

Improved sampling and analysis of images in corneal confocal microscopy.

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Schaldemose, E L; Fontain, F I; Karlsson, P; Nyengaard, J R

2017-10-01

Corneal confocal microscopy (CCM) is a noninvasive clinical method to analyse and quantify corneal nerve fibres in vivo. Although the CCM technique is in constant progress, there are methodological limitations in terms of sampling of images and objectivity of the nerve quantification. The aim of this study was to present a randomized sampling method of the CCM images and to develop an adjusted area-dependent image analysis. Furthermore, a manual nerve fibre analysis method was compared to a fully automated method. 23 idiopathic small-fibre neuropathy patients were investigated using CCM. Corneal nerve fibre length density (CNFL) and corneal nerve fibre branch density (CNBD) were determined in both a manual and automatic manner. Differences in CNFL and CNBD between (1) the randomized and the most common sampling method, (2) the adjusted and the unadjusted area and (3) the manual and automated quantification method were investigated. The CNFL values were significantly lower when using the randomized sampling method compared to the most common method (p = 0.01). There was not a statistical significant difference in the CNBD values between the randomized and the most common sampling method (p = 0.85). CNFL and CNBD values were increased when using the adjusted area compared to the standard area. Additionally, the study found a significant increase in the CNFL and CNBD values when using the manual method compared to the automatic method (p ≤ 0.001). The study demonstrated a significant difference in the CNFL values between the randomized and common sampling method indicating the importance of clear guidelines for the image sampling. The increase in CNFL and CNBD values when using the adjusted cornea area is not surprising. The observed increases in both CNFL and CNBD values when using the manual method of nerve quantification compared to the automatic method are consistent with earlier findings. This study underlines the importance of improving the analysis of the

Preliminary study of the correlation between refractive error and corneal refractive power, corneal asphericity in myopic eye

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Qi-Chao Han

2014-05-01

Full Text Available AIM: To investigate the correlation between myopic refractive error and relative factors, including the corneal refractive power, posterior refractive power, axial length, corneal asphericity coefficient Q value, central cornea thickness(CCTand intraocular pressure(IOP. METHODS:According to the degree of myopia measured by subjective refraction, 138 myopia patients were divided into three subgroups: mild group(-1.00D--3.00D, moderate group(-3.25D--6.00D, high group(>6.00D. The Pentacam anterior segment tomographer(Germany, Oculus Companywas used to measure the corneal refractive power, posterior refractive power, and corneal asphericity in the right eye. IOP, CCT and axial length were measured by a non-contact tonometer and A-scan ultrasonic, respectively. The data was analyzed with a Pearson correlation analysis and one-way ANOVA. RESULTS: The myopic refractive error was negatively correlated with the axial length(r=-0.682, Pr=0.009, P=0.925. The axial length was negatively correlated with corneal refractive power(r=-0.554, Pr=0.674, Pr=-0.375, P=0.01. There was no significantly correlation between the myopic refractive error and CCT, IOP(r=-0.138, P=0.141; r=-0.121, P=0.157. CONCLUSION:The corneal refractive power plays the role of emmetropization during the development of myopia. There is clinic significance for the correlation between Q value and refractive error, IOP to guide the corneal refractive surgery.

Optical coherence elastography for evaluating customized riboflavin/UV-A corneal collagen crosslinking

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Singh, Manmohan; Li, Jiasong; Vantipalli, Srilatha; Han, Zhaolong; Larin, Kirill V.; Twa, Michael D.

2017-09-01

UV-induced collagen cross-linking is a promising treatment for keratoconus that stiffens corneal tissue and prevents further degeneration. Since keratoconus is generally localized, the efficacy of collagen cross-linking (CXL) treatments could be improved by stiffening only the weakened parts of the cornea. Here, we demonstrate that optical coherence elastography (OCE) can spatially resolve transverse variations in corneal stiffness. A short duration (≤1 ms) focused air-pulse induced low amplitude (≤10 μm) deformations in the samples that were detected using a phase-stabilized optical coherence tomography system. A two-dimensional map of material stiffness was generated by measuring the damped natural frequency (DNF) of the air-pulse induced response at various transverse locations of a heterogeneous phantom mimicking a customized CXL treatment. After validation on the phantoms, similar OCE measurements were made on spatially selective CXL-treated in situ rabbit corneas. The results showed that this technique was able to clearly distinguish the untreated and CXL-treated regions of the cornea, where CXL increased the DNF of the cornea by ˜51%. Due to the noncontact nature and minimal excitation force, this technique may be valuable for in vivo assessments of corneal biomechanical properties.

An active artificial cornea with the function of inducing new corneal tissue generation in vivo-a new approach to corneal tissue engineering

International Nuclear Information System (INIS)

Huang Yaoxiong; Li Qinhua

2007-01-01

An active artificial cornea which can perform the function of inducing new cornea generation in vivo but does not need culture cells in vitro and which has similar optical and mechanical properties to those of the human cornea was constructed. An animal keratoplasty experiment using the artificial cornea as the implant showed that the animals' corneas could keep smooth surface and clear stroma postoperatively, and that the repopulation of the host's keratocytes, the degradation of the implant and new corneal tissue generation were completed at 5-6 months after surgery. Such an artificial cornea has several advantages over other corneal equivalents constructed in the typical way of tissue engineering: in having similar mechanical and optical properties to those of the human cornea and with no exogenetic cells, it can be used universally in different implantation surgeries without immunoreaction; it is easy to prepare and process into different shapes and sizes on a large scale, and suitable for long-distance transportation and long-term storage. All these characteristics make it a new approach to cornea tissue engineering having potential in many clinical applications

Application of Novel Drugs for Corneal Cell Regeneration

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Sang Beom Han

2018-01-01

Full Text Available Corneal transplantation has been the only treatment method for corneal blindness, which is the major cause of reversible blindness. However, despite the advancement of surgical techniques for corneal transplantation, demand for the surgery can never be met due to a global shortage of donor cornea. The development of bioengineering and pharmaceutical technology provided us with novel drugs and biomaterials that can be used for innovative treatment methods for corneal diseases. In this review, the authors will discuss the efficacy and safety of pharmacologic therapies, such as Rho-kinase (ROCK inhibitors, blood-derived products, growth factors, and regenerating agent on corneal cell regeneration. The promising results of these agents suggest that these can be viable options for corneal reconstruction and visual rehabilitation.

Generation of corneal epithelial cells from induced pluripotent stem cells derived from human dermal fibroblast and corneal limbal epithelium.

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Ryuhei Hayashi

Full Text Available Induced pluripotent stem (iPS cells can be established from somatic cells. However, there is currently no established strategy to generate corneal epithelial cells from iPS cells. In this study, we investigated whether corneal epithelial cells could be differentiated from iPS cells. We tested 2 distinct sources: human adult dermal fibroblast (HDF-derived iPS cells (253G1 and human adult corneal limbal epithelial cells (HLEC-derived iPS cells (L1B41. We first established iPS cells from HLEC by introducing the Yamanaka 4 factors. Corneal epithelial cells were successfully induced from the iPS cells by the stromal cell-derived inducing activity (SDIA differentiation method, as Pax6(+/K12(+ corneal epithelial colonies were observed after prolonged differentiation culture (12 weeks or later in both the L1B41 and 253G1 iPS cells following retinal pigment epithelial and lens cell induction. Interestingly, the corneal epithelial differentiation efficiency was higher in L1B41 than in 253G1. DNA methylation analysis revealed that a small proportion of differentially methylated regions still existed between L1B41 and 253G1 iPS cells even though no significant difference in methylation status was detected in the specific corneal epithelium-related genes such as K12, K3, and Pax6. The present study is the first to demonstrate a strategy for corneal epithelial cell differentiation from human iPS cells, and further suggests that the epigenomic status is associated with the propensity of iPS cells to differentiate into corneal epithelial cells.

Corneal topography with an aberrometry-topography system.

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Mülhaupt, Michael; Dietzko, Sven; Wolffsohn, James; Bandlitz, Stefan

2018-05-07

To investigate the agreement between the central corneal radii and corneal eccentricity measurements generated by the new Wave Analyzer 700 Medica (WAV) compared to the Keratograph 4 (KER) and to test the repeatability of the instruments. 20 subjects (10 male, mean age 29.1 years, range 21-50 years) were recruited from the students and staff of the Cologne School of Optometry. Central corneal radii for the flat (r c/fl ) and steep (r c/st ) meridian as well as corneal eccentricity for the nasal (e nas ), temporal (e temp ), inferior (e inf ) and superior (e sup ) directions were measured using WAV and KER by one examiner in a randomized order. Central radii of the flat (r c/fl ) and steep (r c/st ) meridian measured with both instruments were statically significantly correlated (r = 0.945 and r = 0.951; p  0.05). Limits of agreement (LoA) indicate a better repeatability for the KER compared to WAV. Corneal topography measurements captured with the WAV were strongly correlated with the KER. However, due to the differences in measured corneal radii and eccentricities, the devices cannot be used interchangeably. For corneal topography the KER demonstrated better repeatability. Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Rechazo y retrasplante corneal Corneal rejection and re-transplantation

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Miguel O Mokey Castellanos

2007-06-01

Full Text Available Se efectuó una investigación observacional análítica retrospectiva, sobre los transplantes corneales efectuados en el Servicio de Oftalmología del Hospital "Hermanos Ameijeiras. Rechazaron 76 pacientes, que se compararon con un control de 89 pacientes, que en un período similar no tuvieron rechazo. El queratocono fue la afección corneal que predominó. El primer lugar en los rechazos correspondió a queratoherpes (43,5 %. El menor índice de rechazo fue para el queratocono (8,8 %. Se analizó la multiplicidad de rechazos; y fue frecuente que se presentara un solo rechazo, aunque sí hubo congruencia entre el número de rechazos y la necesidad de retrasplantes. Se encontró que los resultados de la conducta médica o quirúrgica se relacionaban con la causa. Se calcula un índice de supervivencia (Kaplan-Meier, que concluye que en los primeros dos años existe menos posibilidad de aparición de rechazoAn retrospective observational analytical research was conducted on corneal transplants performed at Ophthalmological Service in “Hermanos Ameijeiras” hospital . Seventy six patients had graft rejection and were compared to a control group of 89 patients that did not present rejection in the same period of time. Keratoconus was the prevailing corneal problem. The highest rejection rate corresponded to keratoherpes (43,5% whereas the lowest rate was for keratoconus (8,8%. Multiplicity of rejections was analyzed and it was found that mostly one graft rejection occured, but number of rejections was associated with the need of re-transplantation. It was found that the results of medical or surgical performance were related to the cause of graft rejection. A survival index (Kaplan-Meier was estimated, which showed that occurence of graf rejection is less probable in the first two years

Subthreshold UV radiation-induced peroxide formation in cultured corneal epithelial cells: the protective effects of lactoferrin

International Nuclear Information System (INIS)

Shimmura, Shigeto; Suematsu, Makoto; Shimoyama, Masaru; Oguchi, Yoshihisa; Ishimura, Yuzuru

1996-01-01

Acute exposure to suprathreshold ultraviolet B radiation (UV-B) is known to cause photokeratitis resulting from the necrosis and shedding of corneal epithelial cells. However, the corneal effects of low dose UV-B in the environmental range is less clear. In this study, subthreshold UV-B was demonstrated to cause non-necrotic peroxide formation in cultured corneal epithelial cells, which was attenuated by the major tear protein lactoferrin. Intracellular oxidative insults and cell viability of rabbit corneal epithelial cells (RCEC) were assessed by dual-color digital microfluorography using carboxydichlorofluorescin (CDCFH) diacetate bis (acetoxymethyl) ester, a hydroperoxide-sensitive fluoroprobe, and propidium iodode (PI) respectively. The magnitude of UV-induced oxidative insults was calibrated by concentrations of exogenously applied H 2 O 2 which evoke compatible levels of CDCFH oxidation. Exposure of RCEC to low-dose UV-B (2.0 mJ cm -2 at 313 nm, 10.0 mJ cm -2 total UV-B) caused intracellular oxidative changes which were equivalent to those elicited by 240 μM hydrogen peroxide under the conditions of the study. The changes were dose dependent, non-necrotic, and were partially inhibited by lactoferrin ( 1 mg ml -1 ) but not by iron-saturated lactoferrin. Pretreatment with deferoxamine (2 mΜ) or catalase (100 U ml -1 ) also attenuated the UV-induced oxidative stress. The results indicate that UV-B comparable to solar irradiation levels causes significant intracellular peroxide formation in corneal epithelial cells, and that lactoferrin in tears may have a physiological role in protecting the corneal epithelium from solar UV irradiation. (Author)

Granular corneal dystrophy

OpenAIRE

Castillo Pérez, Alexeide de la C; Vilches Lescaille, Daysi; Noriega, Justo Luis; Martínez Balido, Daneel; León Balbón, Bárbaro Ramón; León Bernal, Danysleidi

2015-01-01

Las distrofias corneales constituyen un conjunto de enfermedades que presentan, en su mayoría, una baja incidencia y se caracterizan por acúmulo de material hialino o amiloide que disminuyen la transparencia corneal. La distrofia granular es una enfermedad autosómica dominante que presenta opacidades grises en el estroma superficial central de la córnea y se hacen visibles en la primera y segunda décadas de la vida, lo que provoca disminución de la visión más significativa cerca de los 40 año...

Descemet's stripping-automated endothelial keratoplasty for symptomatic thioridazine deposits in the cornea

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Masoumeh Mohebbi

2017-01-01

Full Text Available The aim of this study was to use Descemet's Stripping-automated Endothelial Keratoplasty (DSAEK as a novel treatment to remove thioridazine corneal deposits. A 53-year-old female presented with a 3-month history of visual loss and glare. She had been taking thioridazine (100 mg/day for 1 year for a psychiatric disorder. Dense yellowish-brown deposits had developed in the posterior stroma. Thioridazine was discontinued, and she was switched to fluoxetine. One year after discontinuation of thioridazine, her symptoms and signs did not resolve. Standard DSAEK was performed on her left eye. Two weeks after DSAEK, an anterior subcapsular cataract was detected in the same eye. Phacoemulsification and intraocular lens implantation were performed after 3 months. The left cornea became completely clear after DSAEK, and the patient's best-corrected visual acuity improved from 20/40 to 20/20 at 1 month after cataract surgery. All-visual symptoms such as glare and halos improved postoperatively. We suggest that DSAEK can be used as a novel treatment to reduce vision problems caused by thioridazine-induced corneal deposits.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics.

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Gonzalez-Salinas, Roberto; Garza-Leon, Manuel; Saenz-de-Viteri, Manuel; Solis-S, Juan C; Gulias-Cañizo, Rosario; Quiroz-Mercado, Hugo

2017-08-22

To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems . A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ® phacoemulsification system or the gravity-fluidics Infiniti ® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared. A mean age of 68.3 ± 9.8 years was found (range 57-92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R 2  = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R 2  = 0.112, P = 0.046) and AT values (r = 0.156, R 2  = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P Infiniti ® IP system for NII and NIII cataracts.

Prevalence and causes of corneal blindness.

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Wang, Haijing; Zhang, Yaoguang; Li, Zhijian; Wang, Tiebin; Liu, Ping

2014-04-01

The study aimed to assess the prevalence and causes of corneal blindness in a rural northern Chinese population. Cross-sectional study. The cluster random sampling method was used to select the sample. This population-based study included 11 787 participants of all ages in rural Heilongjiang Province, China. These participants underwent a detailed interview and eye examination that included the measurement of visual acuity, slit-lamp biomicroscopy and direct ophthalmoscopy. An eye was considered to have corneal blindness if the visual acuity was blindness and low vision. Among the 10 384 people enrolled in the study, the prevalence of corneal blindness is 0.3% (95% confidence interval 0.2-0.4%). The leading cause was keratitis in childhood (40.0%), followed by ocular trauma (33.3%) and keratitis in adulthood (20.0%). Age and illiteracy were found to be associated with an increased prevalence of corneal blindness. Blindness because of corneal diseases in rural areas of Northern China is a significant public health problem that needs to be given more attention. © 2013 Royal Australian and New Zealand College of Ophthalmologists.

Two cases of corneal perforation after oral administration of nonsteroidal anti-inflammatory drugs: oral NSAID-induced corneal damage.

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Masuda, Ikuya; Matsuo, Toshihiko; Okamoto, Kazuo; Matsushita, Kyoko; Ohtsuki, Hiroshi

2010-01-01

To report 2 cases of corneal perforation associated with the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs). In a 62-year-old woman and a 79-year-old woman, corneal perforation occurred after 7 days and 5 months of oral NSAIDs administration, respectively. After NSAIDs were discontinued, the cornea epithelialized and the anterior chamber formed within 14 and 10 days, respectively. It is well known that topical NSAIDs cause corneal perforation. Observations in the present cases suggest that the oral administration of NSAIDs may also cause corneal damage, and hence, medical professionals should consider the risk of damage to the cornea when administering these drugs orally.

Comparison of different types of phacoemulsification tips. I. Quantitative analysis of elemental composition and tip surface microroughness.

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Tsaousis, Konstantinos T; Werner, Liliana; Perez, Jesus Paulo; Li, He J; Reiter, Nicholas; Guan, Jia J; Mamalis, Nick

2016-09-01

To evaluate the elemental composition of phacoemulsification tips and their surface roughness in the microscale. John A. Moran Eye Center and Utah Nanofab, College of Engineering, University of Utah, Salt Lake City, Utah, USA. Experimental study. Seven types of phacoemulsification tips were studied. The phaco tips were examined through energy-dispersive x-ray spectroscopy (EDS) and x-ray photoelectron spectroscopy (XPS) for elemental composition. In addition, the roughness of the opening in all tips was assessed through 3-dimensional white-light interferometry. Elemental analysis showed considerable differences in the surface layers between manufacturers. Alcon tips had a thinner oxidized titanium (Ti) layer in their surface. Through XPS, vanadium was not detected in the superficial layers of any tip, but only in deeper levels. The microroughness surface analysis showed comparable results regarding their root-mean-square (RMS) metric. Maximum peak valley distance values varied and appeared to be dependent on the quality of material process rather than the material itself. Phacoemulsification tips are made of Ti alloys and showed differences between models, especially regarding their composition in the superficial layers. Their opening end roughness showed an overall appropriate RMS value of less than 1.0 μm in all cases. The existence of small defected areas highlights the importance of adequate quality control of these critical surgical instruments. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Applanation optical coherence elastography: noncontact measurement of intraocular pressure, corneal biomechanical properties, and corneal geometry with a single instrument

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Singh, Manmohan; Han, Zhaolong; Nair, Achuth; Schill, Alexander; Twa, Michael D.; Larin, Kirill V.

2017-02-01

Current clinical tools provide critical information about ocular health such as intraocular pressure (IOP). However, they lack the ability to quantify tissue material properties, which are potent markers for ocular tissue health and integrity. We describe a single instrument to measure the eye-globe IOP, quantify corneal biomechanical properties, and measure corneal geometry with a technique termed applanation optical coherence elastography (Appl-OCE). An ultrafast OCT system enabled visualization of corneal dynamics during noncontact applanation tonometry and direct measurement of micro air-pulse induced elastic wave propagation. Our preliminary results show that the proposed Appl-OCE system can be used to quantify IOP, corneal biomechanical properties, and corneal geometry, which builds a solid foundation for a unique device that can provide a more complete picture of ocular health.

Risk factors for corneal ectasia after LASIK.

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Tabbara, Khalid F; Kotb, Amgad A

2006-09-01

To establish a grading system that helps identify high-risk individuals who may experience corneal ectasia after LASIK. Retrospective, comparative, interventional case series. One hundred forty-eight consecutive patients (148 eyes) were included in this study. Thirty-seven patients who underwent LASIK at other refractive centers experienced corneal ectasia in 1 eye after LASIK. One hundred eleven eyes of 111 patients who underwent successful LASIK during the same period were age and gender matched and served as controls. All patients underwent preoperative and postoperative topographic analysis of the cornea. The follow-up period in both groups of patients ranged from 2 to 5 years, with a mean follow-up of 3.6 years. All patients underwent LASIK for myopia (spherical equivalent, -4.00 to -8.00 diopters). Corneal keratometry, oblique cylinder, pachymetry, posterior surface elevation, difference between the inferior and superior corneal diopteric power, and posterior best sphere fit (BSF) over anterior BSF were given a grade of 1 to 3 each. An ectasia grading system was established, and the cumulative risk score was assessed. Patients who had a grade of 7 or less showed no evidence of corneal ectasia, whereas 16 (59%) of 27 patients who had a grade of 8 to 12 had corneal ectasia. Twenty-one (100%) of 21 patients with a grade of more than 12 had corneal ectasia after LASIK (P<0.0001). A risk score may help in the prediction of patients who are at risk of experiencing corneal ectasia after LASIK. A prospective clinical study is needed to assess the validity of these risk factors.

Customized toric intraocular lens implantation for correction of extreme corneal astigmatism due to corneal scarring

Directory of Open Access Journals (Sweden)

R Bassily

2010-03-01

Full Text Available R Bassily, J LuckOphthalmology Department, Royal United Hospital, Combe Park, Bath, UKAbstract: A 76-year-old woman presented with decreased visual function due to cataract formation. Twenty-five years prior she developed right sided corneal ulceration that left her with 10.8 diopters (D of irregular astigmatism at 71.8° (steep axis. Her uncorrected visual acuity was 6/24 and could only ever wear a balanced lens due to the high cylindrical error. Cataract surgery was planned with a custom designed toric intraocular lens (IOL with +16.0 D sphere inserted via a wound at the steep axis of corneal astigmatism. Postoperative refraction was -0.75/+1.50 × 177° with a visual acuity of 6/9 that has remained unchanged at six-week follow-up with no IOL rotation. This case demonstrates the value of high power toric IOLs for the correction of pathological corneal astigmatism.Keywords: intraocular lens, corneal ulceration, visual acuity, scarring

Pharmacologic strategies in the prevention and treatment of corneal transplant rejection.

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Tabbara, Khalid F

2008-06-01

Corneal transplantation remains one of the most successful organ transplantation procedures in humans. The unique structure of the cornea, with its absence of blood vessels and corneal lymphatic, allows the survival of corneal allograft. Recent advances in sutures, storage media, microsurgical instrumentation, and new pharmacological strategies have greatly improved the success of corneal transplantation and the prevention of corneal allograft rejection. Our strategies in the management and prevention of corneal graft rejection can modify and improve the survival of corneal allografts. Preoperative evaluation, understanding the risk factors, and management of ocular surface disorders may greatly improve the survival of the corneal transplant. Early recognition of corneal allograft rejection and aggressive treatment may improve the survival of the corneal graft. Furthermore, patients who undergo corneal transplantation should be maintained under close ophthalmic surveillance and patients should be informed to report immediately whenever symptoms of corneal graft rejection occur. The mainstay of therapy is topical corticosteroids. In severe cases, periocular, intravenous, and oral corticosteroids therapy can be rendered. New therapeutic modalities such as cyclosporine, tacrolimus, daclizumab, mycophenolate mofetil, leflunomide, rapamycin, and others may prove to be of help in the prevention and treatment of corneal graft rejection. Early recognition of corneal graft rejection and prompt treatment are mandatory for the successful survival of the corneal allograft.

Study on the establishment of corneal alkali chemical injury on rats

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Nan Hu

2013-06-01

Full Text Available AIM:To investigate the appropriate methods to establish corneal alkali chemical injury on rats. METHODS:The rats(n=87were randomly divided into three groups. Corneal alkali injury was induced by placing 1mol/L NaOH soaked filter paper on the limbus of right cornea for 20 seconds(group A, n=34or 40 seconds(group B, n=23, and on the central axis of the right cornea for 40 seconds(group C, n=30respectively. Corneal transparency, corneal ulceration, and corneal neovascularization were observed and recorded under slit- lamp biomicroscope on day 7 post-operation. RESULTS: Incidence of corneal ulceration, corneal perforation and positive rate of corneal fluorescein staining in limbal corneal injury groups(group A and Bwere significantly higher than that of central corneal injury group(group C(P<0.05. Incidence of corneal ulceration and corneal perforation in group B was significantly higher than group A(P<0.05. Corneal neovascularization was observed in all three groups. CONCLUSION: Corneal alkali burns induced by 3mm diameter central cornea injury are fit for the study of corneal neovascularization, while those induced by limbus injury for 20 seconds are fit for the study on limbal stem cells deficiency.

Recovery of Corneal Endothelial Cells from Periphery after Injury.

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Sang Ouk Choi

Full Text Available Wound healing of the endothelium occurs through cell enlargement and migration. However, the peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium in endothelial injury.To investigate the recovery process of corneal endothelial cells (CECs from corneal endothelial injury.Three patients with unilateral chemical eye injuries, and 15 rabbit eyes with corneal endothelial chemical injuries were studied. Slit lamp examination, specular microscopy, and ultrasound pachymetry were performed immediately after chemical injury and 1, 3, 6, and 9 months later. The anterior chambers of eyes from New Zealand white rabbits were injected with 0.1 mL of 0.05 N NaOH for 10 min (NaOH group. Corneal edema was evaluated at day 1, 7, and 14. Vital staining was performed using alizarin red and trypan blue.Specular microscopy did not reveal any corneal endothelial cells immediately after injury. Corneal edema subsided from the periphery to the center, CEC density increased, and central corneal thickness decreased over time. In the animal study, corneal edema was greater in the NaOH group compared to the control at both day 1 and day 7. At day 1, no CECs were detected at the center and periphery of the corneas in the NaOH group. Two weeks after injury, small, hexagonal CECs were detected in peripheral cornea, while CECs in mid-periphery were large and non-hexagonal.CECs migrated from the periphery to the center of the cornea after endothelial injury. The peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium.

Evaluation of corneal symmetry after UV corneal crosslinking for keratoconus

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Mofty H

2017-11-01

Full Text Available Hanan Mofty,1,2 Khaled Alzahrani,2 Fiona Carley,3 Sophie Harper,3 Arun Brahma,3 Leon Au,3 Debbie Morley,3 M Chantal Hillarby2 1Optometry Department, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 3Manchester Royal Eye Hospital, Manchester, UK Purpose: The purpose of this study was to assess UV corneal crosslinking (CXL treatment outcomes for keratoconus by evaluating the corneal regularity in patients through follow-up using the Oculus Pentacam.Patients and methods: A total of 18 eyes from CXL patients with keratoconus were studied before and after CXL treatment, and six eyes from six patients who were not treated with CXL served as controls. Treated patients had Pentacam images taken before CXL treatment and regularly 3 months post treatment up to the 12th month. Controls were imaged during their first appointment and after 12 months. Symmetry and asphericity were evaluated and correlated with both best-corrected visual acuity (BCVA and maximum K-readings.Results: In the CXL-treated group, there was a significant improvement in the index of symmetrical variation (ISV and keratoconus index (KI at 3 months and in the index of height asymmetry (IHA and minimum radius of curvature (Rmin at 9 months post treatment. On the contrary, the untreated group’s indices showed some significant worsening in ISV, KI, central keratoconus index (CKI, and Rmin. A novel finding in our study was a slight positive shift of anterior asphericity in the 6 mm, 7 mm, and 8 mm 3 months after treatment, which had a correlation with BCVA (R2=0.390, p=0.053 and a strong correlation with maximum K-reading (R2=0.690, p=0.005. However, the untreated group had no significant changes after 1 year.Conclusion: The corneal asymmetrical shape is associated with the spherical aberration alteration

Ozil IP torsional mode versus combined torsional/longitudinal microcoaxial phacoemulsification.

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Helvacioglu, Firat; Tunc, Zeki; Yeter, Celal; Oguzhan, Hasan; Sencan, Sadik

2012-01-01

To compare the safety and efficacy of microcoaxial phacoemulsification surgeries performed with the Ozil Intelligent Phaco (IP) torsional mode and combined torsional/longitudinal ultrasound (US) mode using the Infiniti Vision System (Alcon Laboratories). In this prospective randomized comparative study, 60 eyes were assigned to 2.2-mm microcoaxial phacoemulsification using the Ozil IP torsional mode (group 1) or combined torsional/longitudinal US mode (group 2). The primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of balanced salt solution (BSS) used, and surgical complications. Both groups included 30 eyes. Mean UST, CDE, and longitudinal and torsional ultrasound amplitudes in group 1 were 1 minute 15±34.33 seconds, 8.74±5.64, 0.43±0.74, and 25.56±8.56, respectively, and these parameters in group 2 were 1 minute 40±51.44 seconds, 9.28±5.99, 3.64±1.55, and 3.71±1.34, respectively. UST and longitudinal amplitudes were found to be significantly low in group 1 (p<0.001, p<0.001), whereas torsional amplitude was found to be significantly high in this group (p=0.001). Mean volumes of BSS used in groups 1 and 2 were 63.30±18.00 cc and 84.50±28.65 cc, respectively (p=0.001). The Ozil IP torsional mode may provide more effective lens removal than the combined torsional/longitudinal US mode with a lower UST and volume of BSS used.

Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis.

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Zhu, Wei; Han, Yunfei; Cui, Changxia; Xu, Wenwen; Wang, Xuan; Dou, Xiaoxiao; Xu, Linlin; Xu, Yanyun; Mu, Guoying

2018-01-01

The aim of this study was to analyze the effects of corneal crosslinking (CXL) combined with phototherapeutic keratectomy (PTK) and photorefractive keratectomy (PRK) in halting the progression and improving the visual function of corneal ectasia after laser in situ keratomileusis (LASIK). PTK-PRK-CXL was performed on 14 eyes of 14 patients who developed corneal ectasia after LASIK. The visual acuity, spherical refraction and cylinder, corneal topography indices, thinnest corneal thickness (TCT), and endothelial cell count were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively. The mean uncorrected visual acuity improved significantly from 0.64 ± 0.36 logMAR preoperatively to 0.19 ± 0.12 logMAR at 12 months of follow-up (p 0.05) beyond 6 months after treatment. PTK-PRK-CXL is a promising procedure to halt the progression of post-LASIK keratectasia with significant visual quality improvement. © 2018 S. Karger AG, Basel.

Research on mouse model of grade II corneal alkali burn

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Jun-Qiang Bai

2016-04-01

Full Text Available AIM: To choose appropriate concentration of sodium hydroxide (NaOH solution to establish a stable and consistent corneal alkali burn mouse model in grade II. METHODS: The mice (n=60 were randomly divided into four groups and 15 mice each group. Corneal alkali burns were induced by placing circle filter paper soaked with NaOH solutions on the right central cornea for 30s. The concentrations of NaOH solutions of groups A, B, C, and D were 0.1 mol/L, 0.15 mol/L , 0.2 mol/L, and 1.0 mol/L respectively. Then these corneas were irrigated with 20 mL physiological saline (0.9% NaCl. On day 7 postburn, slit lamp microscope was used to observe corneal opacity, corneal epithelial sodium fluorescein staining positive rate, incidence of corneal ulcer and corneal neovascularization, meanwhile pictures of the anterior eyes were taken. Cirrus spectral domain optical coherence tomography was used to scan cornea to observe corneal epithelial defect and corneal ulcer. RESULTS: Corneal opacity scores ( were not significantly different between the group A and group B (P=0.097. Incidence of corneal ulcer in group B was significantly higher than that in group A (P=0.035. Incidence of corneal ulcer and perforation rate in group B was lower than that in group C. Group C and D had corneal neovascularization, and incidence of corneal neovascularization in group D was significantly higher than that in group C (P=0.000. CONCLUSION: Using 0.15 mol/L NaOH can establish grade II mouse model of corneal alkali burns.

Results of endocapsular phacofracture debulking of hard cataracts

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Davison JA

2015-07-01

Full Text Available James A Davison Wolfe Eye Clinic, Marshalltown, IA, USA Purpose/aim of the study: To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal.Materials and methods: A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26, which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP] strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE, 3 months postoperative surgically induced astigmatism (SIA, and corneal endothelial cell density (ECD losses.Results: No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories.Conclusion: The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip. Keywords: astigmatism, cataract, corneal endothelium, phacoemulsification, viscoelastic

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems

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Chen, Ming; Anderson, Erik; Hill, Geoffrey; Chen, John J; Patrianakos, Thomas

2015-01-01

Ming Chen,1 Erik Anderson,2 Geoffrey Hill,3 John J Chen,4 Thomas Patrianakos2 1Department of Surgery, University of Hawaii, Honolulu, HI, 2Department of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, 3Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 4Biostatistics Core, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA Purpose: To compare cumulative dissipated energy between two phacoemulsification mac...

Corneal Laceration

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Patients with Fuchs Endothelial Dystrophy and Cataract Undergoing Descemet Stripping Automated Endothelial Keratoplasty and Phacoemulsification with Intraocular Lens Implant: Staged versus Combined Procedure Outcomes

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Evripidis Sykakis

2015-01-01

Full Text Available Purpose. To compare the surgical outcomes of staged and combined phacoemulsification with intraocular lens implant (phaco+IOL and Descemet stripping automated endothelial keratoplasty (DSAEK in patients with Fuchs’ endothelial dystrophy and cataract. Setting. Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK. Methods. Retrospective study of patients who had combined phaco+IOL and DSAEK (group 1 or phaco+IOL followed within 2 months by DSAEK (group 2. Patients who had previous eye surgery or any other ocular comorbidities were excluded. Results. There were 28 eyes in group 1 and 31 in group 2. There were no significant differences in the demographics and corneal tissue characteristics of the two groups. The endothelial disc dislocation and rebubbling rate within 1 week in group 1 was 21.42% and in group 2 was 3.2% P=0.04, while the endothelial cell density at 12 months was 1510±433 for group 1 and 1535±482 for group 2 P=0.89. The mean 12-month logMAR visual acuity was 0.28±0.24 for group 1 and 0.33±0.15 for group 2 P=0.38. Conclusions. Although the combined procedure seems to be associated with a higher complication rate the final outcomes seem to be similar to both methods.

Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract.

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Valenzuela, Felipe; Browne, Andrew; Srur, Miguel; Nieme, Carlos; Zanolli, Mario; López-Solís, Remigio; Traipe, Leonidas

2016-02-01

To examine the indications, safety, efficacy, and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery. A retrospective case review of 35 eyes (31 patients) subjected to combined phacoemulsification and Ahmed glaucoma drainage implant surgery. Demographic characteristics of the study population, indications for combined surgery, and operative and postoperative complications were recorded. Visual acuity, intraocular pressure (IOP), and number of glaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as IOP ≤ 21 mm Hg without medication, qualified success if IOP ≤ 21 mm Hg with ≥ 1 medications, and failure if IOP>21 mm Hg or ≤ 5 mm Hg on ≥ 2 consecutive visits. Mean follow-up was 29.5 months (range, 6 to 87 mo). The most common indication for combined surgery was a history of prior failed trabeculectomy (60%). Postoperative visual acuity improved in 30 of 35 eyes (85%) (PAhmed glaucoma drainage implant surgery seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP for patients with refractory glaucoma and cataract.

Effect of biometric characteristics on biomechanical properties of the cornea in cataract patient

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Xue-Fei Song

2016-06-01

Full Text Available AIM: To determine the impact of biometric characteristics on the biomechanical properties of the human cornea using the ocular response analyzer (ORA and standard comprehensive ophthalmic examinations before and after standard phacoemulsification. METHODS: This study comprised 54 eyes with cataract with significant lens opacification in stages I or II that underwent phacoemulsification (2.8 mm incision. Corneal hysteresis (CH, corneal resistance factor (CRF, Goldmann-correlated intraocular pressure (IOPg, and corneal-compensated intraocular pressure (IOPcc were measured by ORA preoperatively and at 1mo postoperatively. Biometric characteristics were derived from corneal topography [TMS-5, anterior equivalent (EQTMS and cylindric (CYLTMS power], corneal tomography [Casia, anterior and posterior equivalent (EQaCASIC, EQpCASIA and cylindric (CYLaCASIA, CYLpCASIA power], keratometry [IOLMaster, anterior equivalent (EQIOL and cylindric (CYLIOL power] and autorefractor [anterior equivalent (EQAR]. Results from ORA were analyzed and correlated with those from all other examinations taken at the same time point. RESULTS: Preoperatively, CH correlated with EQpCASIA and CYLpCASIA only (P=0.001, P=0.002. Postoperatively, IOPg and IOPcc correlated with all equivalent powers (EQTMS, EQIOL, EQAR, EQaCASIA and EQpCASIA (P=0.001, P=0.007, P=0.001, P=0.015, P=0.03 for IOPg and P<0.001, P=0.003, P<0.001, P=0.009, P=0.014 for IOPcc. CH correlated postoperatively with EQaCASIA and EQpCASIC only (P=0.021, P=0.022. CONCLUSION: Biometric characteristics may significantly affect biomechanical properties of the cornea in terms of CH, IOPcc and IOPg before, but even more after cataract surgery.

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification.

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Ahmad, Nauman; Zahoor, Abdul; Motowa, Saeed A; Jastaneiah, Saba; Riad, Waleed

2012-01-01

Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. Ptopical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification

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Ashraf Ahmed Nossair

2017-01-01

Full Text Available Purpose. To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification. Methods. A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD failed to sufficiently deepen the anterior chamber. Results. Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92% preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%. Postoperative follow-up period was 22.88 ± 10.24 (4–39 months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted. Conclusion. Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification.

Crystalline Subtype of Pre-Descemetic Corneal Dystrophy

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Rosa Dolz-Marco

2014-01-01

Full Text Available Purpose: To report corneal findings in a familial case of the crystalline subtype of pre- Descemetic corneal dystrophy. Case Report: A 19-year-old girl and her 44-year-old mother were found to have asymptomatic, bilateral, punctiform and multi-colored crystalline opacities across the whole posterior layer of the corneas. Endothelial specular microscopy revealed the presence of white round flecks located at different levels anterior to the endothelium. No systemic abnormalities or medications could be related to account for these findings. Conclusion: To the best of our knowledge, this is the third familial report of this rare corneal disorder. Differential diagnosis may include Schnyder corneal dystrophy, cystinosis, Bietti΄s dystrophy and monoclonal gammopathy.

Crystalline Subtype of Pre-Descemetic Corneal Dystrophy

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Dolz-Marco, Rosa; Gallego-Pinazo, Roberto; Pinazo-Durán, María Dolores; Díaz-Llopis, Manuel

2014-01-01

Purpose To report corneal findings in a familial case of the crystalline subtype of pre-Descemetic corneal dystrophy. Case Report A 19-year-old girl and her 44-year-old mother were found to have asymptomatic, bilateral, punctiform and multi-colored crystalline opacities across the whole posterior layer of the corneas. Endothelial specular microscopy revealed the presence of white round flecks located at different levels anterior to the endothelium. No systemic abnormalities or medications could be related to account for these findings. Conclusion To the best of our knowledge, this is the third familial report of this rare corneal disorder. Differential diagnosis may include Schnyder corneal dystrophy, cystinosis, Bietti´s dystrophy and monoclonal gammopathy. PMID:25279130

Topical Ranibizumab as a Treatment of Corneal Neovascularization

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Ferrari, Giulio; Dastjerdi, Mohammad H.; Okanobo, Andre; Cheng, Sheng-Fu; Amparo, Francisco; Nallasamy, Nambi; Dana, Reza

2014-01-01

Purpose To examine the effect of topical ranibizumab on clinically stable corneal neovascularization (NV). Methods This was a prospective, open-label, monocentric, uncontrolled, non-comparative study. Ten eyes of 9 patients with corneal NV received topical ranibizumab (1%) 4 times a day for 3 weeks with a follow-up of 16 weeks. The main corneal neovascularization outcome measures were: neovascular area (NA), the area occupied by the corneal neovessels; vessel caliber (VC), the mean diameter of the corneal neovessels; and invasion area (IA), the fraction of the total cornea area covered by the vessels. This study was conducted at the Massachusetts Eye and Ear Infirmary, Boston, MA, USA. Results Statistically significant decreases in NA (55.3%, P<0.001), which lasted through 16 weeks, and VC (59%, P<0.001), which continued to improve up to week 16, were observed after treatment. No significant decrease was observed in IA (12.3%, P=0.49). There was no statistically significant change in visual acuity or intraocular pressure. No adverse events ascribed to the treatment were noted. Conclusions Topical application of ranibizumab is effective in reducing the severity of corneal NV in the context of established corneal NV, mostly through decrease in VC rather than IA. PMID:23407316

Corneal changes with accommodation using dual Scheimpflug photography.

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Sisó-Fuertes, Irene; Domínguez-Vicent, Alberto; del Águila-Carrasco, Antonio; Ferrer-Blasco, Teresa; Montés-Micó, Robert

2015-05-01

To assess whether corneal parameters and aberrations are affected by accommodation. Optics Department, University of Valencia, Valencia, Spain. Prospective cross-sectional study. The Galilei G4 dual Scheimpflug device was used to obtain data on the anterior and posterior axial curvatures, total corneal power (TCP), and corneal pachymetry from 3 corneal zones (central: 0.0 up to 4.0 mm; paracentral or mid: 4.0 up to 7.0 mm; peripheral: 7.0 up to 10.0 mm) in young emmetropic eyes in the unaccommodated and 4 accommodated states (from -1.0 to -4.0 diopters [D] in 1.0 D steps). The 2nd-, 3rd-, and 4th-order aberrations as well as the root mean square (RMS) were also determined for the entire cornea at the same accommodative demands. The study evaluated 7 subjects (12 eyes). No significant changes in any measured parameter were found during accommodation for any corneal zone (P > .05). Statistically significant differences were found in the various corneal zones when it was assumed they were constant with accommodation (P the high standard deviation values. Different parameters in various zones of the cornea as well as corneal aberrations were stable during accommodation. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Corneal Biomechanics in Ectatic Diseases: Refractive Surgery Implications

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Ambrósio, Jr, Renato; Correia, Fernando Faria; Lopes, Bernardo; Salomão, Marcella Q.; Luz, Allan; Dawson, Daniel G.; Elsheikh, Ahmed; Vinciguerra, Riccardo; Vinciguerra, Paolo; Roberts, Cynthia J.

2017-01-01

Background: Ectasia development occurs due to a chronic corneal biomechanical decompensation or weakness, resulting in stromal thinning and corneal protrusion. This leads to corneal steepening, increase in astigmatism, and irregularity. In corneal refractive surgery, the detection of mild forms of ectasia pre-operatively is essential to avoid post-operative progressive ectasia, which also depends on the impact of the procedure on the cornea. Method: The advent of 3D tomography is proven as a significant advancement to further characterize corneal shape beyond front surface topography, which is still relevant. While screening tests for ectasia had been limited to corneal shape (geometry) assessment, clinical biomechanical assessment has been possible since the introduction of the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, USA) in 2005 and the Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) in 2010. Direct clinical biomechanical evaluation is recognized as paramount, especially in detection of mild ectatic cases and characterization of the susceptibility for ectasia progression for any cornea. Conclusions: The purpose of this review is to describe the current state of clinical evaluation of corneal biomechanics, focusing on the most recent advances of commercially available instruments and also on future developments, such as Brillouin microscopy. PMID:28932334

Corneal biomechanical properties in healthy children measured by corneal visualization scheimpflug technology.

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He, Miao; Ding, Hui; He, Hong; Zhang, Chi; Liu, Liangping; Zhong, Xingwu

2017-05-17

The aim of this study was to evaluate corneal biomechanical properties in a population of healthy children in China using corneal visualization Scheimpflug technology (CST). All children underwent complete bi-ocular examinations. CST provided intraocular pressure (IOP) and corneal biomechanical parameters, including time, velocity, length and deformation amplitude at first applanation (A1T, A1V, A1L, A1DA), at second applanation (A2T, A2V, A2L, A2DA), highest concavity time (HCT), maximum deformation amplitude (MDA), peak distance (PD), and radius of curvature (RoC). Pearson correlation analysis was used to assess the impacts of demographic factors, central corneal thickness (CCT), spherical equivalent (SE), and IOP on corneal biomechanics. One hundred eight subjects (32 girls and 76 boys) with the mean age of 10.80 ± 4.13 years (range 4 to18 years) were included in the final analyses. The right and left eyes were highly symmetrical in SE (p = 0.082), IOP (p = 0.235), or CCT (p = 0.210). Mean A1T of the right eyes was 7.424 ± 0.340 ms; the left eyes 7.451 ± 0.365 ms. MDA was 0.993 ± 0.102 mm in the right eyes and 0.982 ± 0.100 mm in the left eyes. Mean HCT of the right eyes was 16.675 ± 0.502 ms; the left eyes 16.735 ± 0.555 ms. All CST parameters of both eye were remarkably symmetrical with the exception of A2L (p = 0.006), A1DA (p = 0.025). The majority of CST parameters of both eyes were significantly correlated with CCT and IOP (p children eyes. Several CST biomechanical parameters in children are modified by CCT and IOP.

Corneal Laceration

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Full Text Available ... by something sharp flying into the eye. It can also be caused by something striking the eye ... If the corneal laceration is deep enough it can cause a full thickness laceration. This is when ...

In Vivo Corneal Biomechanical Properties with Corneal Visualization Scheimpflug Technology in Chinese Population

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Ying Wu

2016-01-01

Full Text Available Purpose. To determine the repeatability of recalculated corneal visualization Scheimpflug technology (CorVis ST parameters and to study the variation of biomechanical properties and their association with demographic and ocular characteristics. Methods. A total of 783 healthy subjects were included in this study. Comprehensive ophthalmological examinations were conducted. The repeatability of the recalculated biomechanical parameters with 90 subjects was assessed by the coefficient of variation (CV and intraclass correlation coefficient (ICC. Univariate and multivariate linear regression models were used to identify demographic and ocular factors. Results. The repeatability of the central corneal thickness (CCT, deformation amplitude (DA, and first/second applanation time (A1/A2-time exhibited excellent repeatability (CV% ≤ 3.312% and ICC ≥ 0.929 for all measurements. The velocity in/out (Vin/out, highest concavity- (HC- radius, peak distance (PD, and DA showed a normal distribution. Univariate linear regression showed a statistically significant correlation between Vin, Vout, DA, PD, and HC-radius and IOP, CCT, and corneal volume, respectively. Multivariate analysis showed that IOP and CCT were negatively correlated with Vin, DA, and PD, while there was a positive correlation between Vout and HC-radius. Conclusion. The ICCs of the recalculated parameters, CCT, DA, A1-time, and A2-time, exhibited excellent repeatability. IOP, CCT, and corneal volume significantly influenced the biomechanical properties of the eye.

Corneal surface reconstruction - a short review

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Madhavan H N

2009-01-01

Full Text Available Cornea is the clear, dome-shaped surface that covers the front of the eye and when damage due to burns or injury and several other diseases, stem cells residing in its rim called "limbus" are stimulated to multiply to support growth of new epithelial cells over its surface. If this ready source of stem cells is damaged or destroyed the natural repair is not possible and such a condition is known as corneal limbal stem cell deficiency (CLSCD disease. Stem cell transplant helps such persons to regenerate the corneal surface. Human corneal limbal stem cell transplantation is at present an established procedure with reasonable good clinical outcome particularly when autologous limbal epithelial tissue from a fellow unaffected eye is used. 1, 2 A major concern related to the autograft is the possibility of CLSCD at the donor site, 3 techniques that allowed the expansion of a small limbal biopsy in the laboratory using cell cultures that could be then transplanted to the affected eye have been developed ,4, 5 Human amniotic membrane (HAM is used as a scaffold for both culturing the human limbal epithelial cells and for ocular surface reconstruction with the cultured limbal epithelial cells. 4-7 However, researchers have used alternative scaffolds like collagen 8, fibrin gel 9 and cross-linked gel of fibronectin and fibrin. 10 All these are biological materials and also need for animal 3T3 feeder layer for stem cell cultures. The properties of HAM are unique including antiadhesive effects, bacteriostatic effects, wound protection, pain reduction, and improvement of epithelialization and characteristically lacking imunogenicity. The use of amniotic membrane transplantation (AMT to treat ocular surface abnormalities was first reported by Graziella Pellegrini, chief of stem cell laboratory at Giovanni Paolo Hospital in Venice, Italy, who was the first to demonstrate the limbal stem cell transplant in 1997. Amniotic membrane has been successfully used in

Alloimmunity and Tolerance in Corneal Transplantation.

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Amouzegar, Afsaneh; Chauhan, Sunil K; Dana, Reza

2016-05-15

Corneal transplantation is one of the most prevalent and successful forms of solid tissue transplantation. Despite favorable outcomes, immune-mediated graft rejection remains the major cause of corneal allograft failure. Although low-risk graft recipients with uninflamed graft beds enjoy a success rate ∼90%, the rejection rates in inflamed graft beds or high-risk recipients often exceed 50%, despite maximal immune suppression. In this review, we discuss the critical facets of corneal alloimmunity, including immune and angiogenic privilege, mechanisms of allosensitization, cellular and molecular mediators of graft rejection, and allotolerance induction. Copyright © 2016 by The American Association of Immunologists, Inc.

Corneal thickness: measurement and implications.

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Ehlers, Niels; Hjortdal, Jesper

2004-03-01

The thickness of the cornea was reported in more than 100-year-old textbooks on physiological optics (Helmholtz, Gullstrand). Physiological interest was revived in the 1950s by David Maurice, and over the next 50 years, this 'simple' biological parameter has been studied extensively. Several techniques for its measurement have been described and physiological and clinical significance have been studied. In this review, the different methods and techniques of measurement are briefly presented (optical, ultrasound). While the corneal thickness of many animals are the same over a considerable part of the surface, in the human cornea anterior and posterior curvature are not concentric giving rise to a problem of definition. Based on this the precision and accuracy of determining the central corneal thickness are discussed. Changes in corneal thickness reflects changes in function of the boundary layers, in particular the endothelial barrier. The absolute value of thickness is of importance for the estimation of IOP but also in diagnosis of corneal and systemic disorders. Finally it is discussed to what extent the thickness is a biometric parameter of significance, e.g. in the progression of myopia or in the development of retinal detachment.

A robotic platform for laser welding of corneal tissue

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Rossi, Francesca; Micheletti, Filippo; Magni, Giada; Pini, Roberto; Menabuoni, Luca; Leoni, Fabio; Magnani, Bernardo

2017-07-01

Robotic surgery is a reality in several surgical fields, such as in gastrointestinal surgery. In ophthalmic surgery the required high spatial precision is limiting the application of robotic system, and even if several attempts have been designed in the last 10 years, only some application in retinal surgery were tested in animal models. The combination of photonics and robotics can really open new frontiers in minimally invasive surgery, improving the precision, reducing tremor, amplifying scale of motion, and automating the procedure. In this manuscript we present the preliminary results in developing a vision guided robotic platform for laser-assisted anterior eye surgery. The robotic console is composed by a robotic arm equipped with an "end effector" designed to deliver laser light to the anterior corneal surface. The main intended application is for laser welding of corneal tissue in laser assisted penetrating keratoplasty and endothelial keratoplasty. The console is equipped with an integrated vision system. The experiment originates from a clear medical demand in order to improve the efficacy of different surgical procedures: when the prototype will be optimized, other surgical areas will be included in its application, such as neurosurgery, urology and spinal surgery.

Generation of Femtosecond Laser-Cut Decellularized Corneal Lenticule Using Hypotonic Trypsin-EDTA Solution for Corneal Tissue Engineering

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Man-Il Huh

2018-01-01

Full Text Available Purpose. To establish an optimized and standardized protocol for the development of optimal scaffold for bioengineering corneal substitutes, we used femtosecond laser to process human corneal tissue into stromal lenticules and studied to find the most efficient decellularization method among various reagents with different tonicities. Methods. The decellularization efficacy of several agents (0.1%, 0.25%, and 0.5% of Triton X-100, SDS, and trypsin-EDTA (TE, resp. with different tonicities was evaluated. Of all protocols, the decellularization methods, which efficiently removed nuclear materials examined as detected by immunofluorescent staining, were quantitatively tested for sample DNA and glycosaminoglycan (GAG contents, recellularization efficacy, and biocompatibilities. Results. 0.5% SDS in hypertonic and isotonic buffer, 0.25% TE in hypotonic buffer, and 0.5% TE in all tonicities completely decellularized the corneal lenticules. Of the protocols, decellularization with hypotonic 0.25 and 0.5% TE showed the lowest DNA contents, while the GAG content was the highest. Furthermore, the recellularization efficacy of the hypotonic TE method was better than that of the SDS-based method. Hypotonic TE-treated decellularized corneal lenticules (DCLs were sufficiently transparent and biocompatible. Conclusion. We generated an ideal protocol for DCLs using a novel method. Furthermore, it is possible to create a scaffold using a bioengineered corneal substitute.

Regeneration of defective epithelial basement membrane and restoration of corneal transparency

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Marino, Gustavo K.; Santhiago, Marcony R.; Santhanam, Abirami; Torricelli, Andre A. M.; Wilson, Steven E.

2018-01-01

PURPOSE To study regeneration of the normal ultrastructure of the epithelial basement membrane (EBM) in rabbit corneas that had -9D photorefractive keratectomy (PRK) and developed late haze (fibrosis) with restoration of transparency over one to four months after surgery and in corneas that had incisional wounds. METHODS Twenty-four rabbits had one of their eyes included into one of the two procedure groups (-9D PRK or nearly full-thickness incisional wounds), while the opposite eye serving as unwounded controls. All corneas were evaluated with slit lamp photos, transmission electron microscopy and immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin and collagen type III. RESULTS In the ‘-9D PRK group’, corneas at one month after surgery had dense corneal haze and no evidence of regenerated EBM ultrastructure. By two months after surgery, however, small areas of stromal clearing began to appear within the confluent opacity (lacunae), and these corresponded to small islands of normally-regenerated EBM detected within larger area of the excimer laser-ablated zone with no evidence of normal EBM. By four months after surgery, the EBM was fully-regenerated and the corneal transparency was completely restored to the ablated zone. In the ‘Incisional wound group’, the two dense, linear corneal opacities were observed at one month after surgery and progressively faded by two and three months after surgery. The EBM ultrastructure was fully regenerated at the site of the incisions, including around epithelial plugs that extended into the stroma, by one month after surgery in all eyes. CONCLUSIONS In the rabbit model, spontaneous resolution of corneal fibrosis (haze) after high correction PRK is triggered by regeneration of EBM with normal ultrastructure in the excimer laser- ablated zone. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by one month after surgery

Corneal epithelial wound healing and bactericidal effect of conditioned medium from human uterine cervical stem cells.

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Bermudez, Maria A; Sendon-Lago, Juan; Eiro, Noemi; Treviño, Mercedes; Gonzalez, Francisco; Yebra-Pimentel, Eva; Giraldez, Maria Jesus; Macia, Manuel; Lamelas, Maria Luz; Saa, Jorge; Vizoso, Francisco; Perez-Fernandez, Roman

2015-01-22

To evaluate the effect of conditioned medium from human uterine cervical stem cells (CM-hUCESCs) on corneal epithelial healing in a rat model of dry eye after alkaline corneal epithelial ulcer. We also tested the bactericidal effect of CM-hUCESCs. Dry eye was induced in rats by extraocular lacrimal gland excision, and corneal ulcers were produced using NaOH. Corneal histologic evaluation was made with hematoxylin-eosin (H&E) staining. Real-time PCR was used to evaluate mRNA expression levels of proinflammatory cytokines. We also studied the bactericidal effect of CM-hUCESCs in vitro and on infected corneal contact lenses (CLs) using Escherichia coli and Staphylococcus epidermidis bacteria. In addition, in order to investigate proteins from CM-hUCESCs that could mediate these effects, we carried out a human cytokine antibody array. After injury, dry eyes treated with CM-hUCESCs significantly improved epithelial regeneration and showed reduced corneal macrophage inflammatory protein-1 alpha (MIP-1α) and TNF-α mRNA expression as compared to untreated eyes and eyes treated with culture medium or sodium hyaluronate ophthalmic drops. In addition, we found in CM-hUCESCs high levels of proteins, such as tissue inhibitors of metalloproteinases 1 and 2, fibroblast growth factor 6 and 7, urokinase receptor, and hepatocyte growth factor, that could mediate these effects. In vitro, CM-hUCESCs showed a clear bactericidal effect on both E. coli and S. epidermidis and CLs infected with S. epidermidis. Analyses of CM-hUCESCs showed elevated levels of proteins that could be involved in the bactericidal effect, such as the chemokine (C-X-C motif) ligands 1, 6, 8, 10, and the chemokine (C-C motif) ligands 5 and 20. Treatment with CM-hUCESCs improved wound healing of alkali-injured corneas and showed a strong bactericidal effect on CLs. Patients using CLs and suffering from dry eye, allergies induced by commercial solutions, or small corneal injuries could benefit from this treatment

The subject-fixated coaxially sighted corneal light reflex: a clinical marker for centration of refractive treatments and devices.

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Chang, Daniel H; Waring, George O

2014-11-01

To describe the inconsistencies in definition, application, and usage of the ocular reference axes (optical axis, visual axis, line of sight, pupillary axis, and topographic axis) and angles (angle kappa, lambda, and alpha) and to propose a precise, reproducible, clinically defined reference marker and axis for centration of refractive treatments and devices. Perspective. Literature review of papers dealing with ocular reference axes, angles, and centration. The inconsistent definitions and usage of the current ocular axes, as derived from eye models, limit their clinical utility. With a clear understanding of Purkinje images and a defined alignment of the observer, light source/fixation target, and subject eye, the subject-fixated coaxially sighted corneal light reflex can be a clinically useful reference marker. The axis formed by connecting the subject-fixated coaxially sighted corneal light reflex and the fixation point, the subject-fixated coaxially sighted corneal light reflex axis, is independent of pupillary dilation and phakic status of the eye. The relationship of the subject-fixated coaxially sighted corneal light reflex axis to a refined definition of the visual axis without reference to nodal points, the foveal-fixation axis, is discussed. The displacement between the subject-fixated coaxially sighted corneal light reflex and pupil center is described not by an angle, but by a chord, here termed chord mu. The application of the subject-fixated coaxially sighted corneal light reflex to the surgical centration of refractive treatments and devices is discussed. As a clinically defined reference marker, the subject-fixated coaxially sighted corneal light reflex avoids the shortcomings of current ocular axes for clinical application and may contribute to better consensus in the literature and improved patient outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment Results of Corneal Collagen Cross-Linking Combined with Riboflavin and 440 Nm Blue Light for Bacterial Corneal Ulcer in Rabbits.

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Wei, Shufang; Zhang, Cuiying; Zhang, Shaoru; Xu, Yanyun; Mu, Guoying

2017-10-01

To study the treatment effect of corneal collagen cross-linking (CXL) combined with 440 nm blue light and riboflavin on bacterial corneal ulcer using animal experiments. A total of 21 New Zealand white rabbits that developed Staphylococcus aureus corneal ulcer were randomly divided into three groups. Seven rabbits were used as blank control groups; seven rabbits were treated with CXL combined with riboflavin and 440 nm blue light; and seven rabbits were treated with CXL combined with riboflavin and 370 nm ultraviolet A light. Necrotic tissues or secretions from the ulcer surface, eye secretions, conjunctival hyperemia, hypopyon, corneal infiltration, and pathological changes of the cornea were all observed. The 1st, 3th, and 7th day after CXL treatment, a statistically significant difference was found among the inflammation scores of the three groups. The scores of 440 and 370 groups decreased gradually, significantly lower than that of the control group. Bacterial cultures of 440 and 370 groups turned to be negative while that of the control group remained positive. After 1 day of CXL treatment, pathology pictures of the three groups all showed loss of corneal epithelia with many inflammatory cells in deep stroma. After 7 days of CXL treatment, abscess formed in almost all corneal area in the control group, while in 440 and 370 groups, multilayer healing of corneal epithelia, neovascularization, and many inflammatory cells within ulcers and proliferation of a small amount of fibroblast were seen. CXL combined with riboflavin and 440 nm blue light is effective in treating S. aureus corneal ulcer.

Human tears reveal insights into corneal neovascularization.

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Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

2012-01-01

Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

Clinical Validation of Point-Source Corneal Topography in Keratoplasty

NARCIS (Netherlands)

Vrijling, A C L; Braaf, B.; Snellenburg, J.J.; de Lange, F.; Zaal, M.J.W.; van der Heijde, G.L.; Sicam, V.A.D.P.

2011-01-01

Purpose. To validate the clinical performance of point-source corneal topography (PCT) in postpenetrating keratoplasty (PKP) eyes and to compare it with conventional Placido-based topography. Methods. Corneal elevation maps of the anterior corneal surface were obtained from 20 post-PKP corneas using

Corneal donations in South Africa: A 15-year review.

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York, Nicholas J; Tinley, Christopher

2017-07-28

Corneal pathology is one of the leading causes of preventable blindness in South Africa (SA). A corneal transplant can restore or significantly improve vision in most cases. However, in SA there is a gross shortage of corneal tissue available to ophthalmologists. Little has been published describing the magnitude of the problem. To describe trends in the number of corneal donors per year in SA, the number of corneal transplants performed each year, the origin of donors, the allocation of corneas to the public or private sector, and the demographics of donors. This was a retrospective review of all corneal donations to SA eye banks over the 15-year period 1 January 2002 - 31 December 2016. There was a progressive year-on-year decline in corneal donors over the study period, from 565 per year in 2002 to 89 in 2016. As a direct result, there has been an 85.5% decrease in the number of corneal transplants performed per year using locally donated corneas, from 1 049 in 2002 to 152 in 2016. Of the donors, 48.8% originated from mortuaries, 39.0% from private hospitals and 12.2% from government hospitals; donors from mortuaries showed the most significant decline over the 15-year period, decreasing by 94.8%. Of donated corneas, 79.3% were allocated to the private sector and 21.7% to the public sector. Males comprised 69.1% of donors, while 77.2% were white, 14.0% coloured, 6.3% black and 2.5% Indian/Asian. Donor age demonstrated a bimodal peak at 25 and 55 years. The number of corneal donations in SA has declined markedly, causing the burden of corneal disease requiring transplantation to rise steadily. Population groups with a low donor rate may have cultural and other objections to corneal donation, which should be a major focus of future research and initiatives aimed at reversing the current trends.

Effect of Cycloplegia on Corneal Biometrics and Refractive State.

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Bagheri, Abbas; Feizi, Mohadeseh; Shafii, Aliakbar; Faramarzi, Amir; Tavakoli, Mehdi; Yazdani, Shahin

2018-01-01

To determine changes in refractive state and corneal parameters after cycloplegia with cyclopentolate hydrochloride 1% using a dual Scheimpflug imaging system. In this prospective cross-sectional study patients aged 10 to 40 years who were referred for optometric evaluation enrolled and underwent autorefraction and corneal imaging with the Galilei dual Scheimpflug system before and 30 minutes after twice instillation of medication. Changes in refraction and astigmatism were investigated. Corneal biometrics including anterior and posterior corneal curvatures, total corneal power and corneal pachymetry were compared before and after cycloplegia. Two hundred and twelve eyes of 106 subjects with mean age of 28 ± 5 years including 201 myopic and 11 hyperopic eyes were evaluated. Mean spherical equivalent refractive error before cycloplegia was -3.4 ± 2.6 D. A mean hyperopic shift of 0.4 ± 0.5 D occurred after cycloplegia ( P biometrics should be considered before cataract and refractive surgeries.

Endothelial cell study in a case of Werner′s syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy

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Vasudha Kemmanu

2012-01-01

Full Text Available Werner′s syndrome (WS is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS.

Depósitos corneales de ciprofloxacino Corneal deposits of ciprofloxacin

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Taimi Cárdenas Díaz

2010-01-01

Full Text Available Las fluoroquinolonas son ampliamente utilizadas para el tratamiento de infecciones oculares bacterianas, ya que tienen actividad tanto para grampositivos, como para gramnegativos. Son fármacos seguros, pero se han descrito depósitos blancos cristalinianos en pacientes con administración frecuente y prolongada;en la mayoría de los casos, ellos resuelven de forma lenta al interrumpir el tratamiento. Si esto no ocurre, los depósitos se deben desbridar. Se ilustran 3 casos operados de catarata que llevaron tratamiento con ciprofloxacino en el posoperatorio, en los cuales se presentaron depósitos corneales y aunque disminuyó la agudeza visual, esta se recuperó después de la queratectomía.Fluoroquinolones are broadly used for the treatment of bacterial ocular infections, since they can act upon both grampositive and gramnegative bacteria. They are safe drugs, but white corneal deposits have been described in patients who frequently take this drug for a long period of time. In most of the cases, the deposits disappear slowly after the treatment is interrupted. If this does not happen, the deposits should be eliminated. Three cases operated on from cataract were presented, who had been taken ciprofloxacin in the postoperative stage and had corneal deposits. Although their visual acuity decreased, it recovered after keratectomy.

Molecular characterization and potential sources of aqueous humor bacterial contamination during phacoemulsification with intraocular lens implantation in dogs.

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Lacerda, Luciana C C; de Souza-Pollo, Andressa; Padua, Ivan Ricardo M; Conceição, Luciano F; da Silveira, Camila P Balthazar; Silva, Germana A; Maluta, Renato P; Laus, José L

2018-01-01

Bacterial contamination of the anterior chamber during cataract surgery is one of the main responsible for endophthalmitis postoperative. Phacoemulsification is a less invasive technique for cataract treatment, although it does not exclude the possibility of contamination. In this study, bacterial contaminants of aqueous humor collected pre- and post-phacoemulsification with intraocular lens implantation (IOL) of twenty dogs were identified. As the conjunctival microbiota constitute a significant source of anterior chamber contamination, bacterial isolates from aqueous humor were genetically compared with those present in the conjunctival surface of the patients. Three dogs presented bacterial growth in both aqueous humor and conjunctival surface samples. Bacterial isolates from these samples were grouped according to their genetic profiles by repetitive-element PCR (rep-PCR) and their representatives were identified by 16S rRNA sequencing. Isolates from conjunctival surface were identified as Enterobacter spp., Staphylococcus spp. and S. aureus; and from aqueous humor samples as Enterobacter spp., Pantoea spp., Streptococcus spp. and Staphylococcus spp., respectively in decreasing order of prevalence. According to the rep-PCR analysis, 16.6% of Enterobacter spp. isolates from conjunctival surface were genetically similar to those from aqueous humor. The rest of isolates encountered in aqueous humor were genetically distinct from those of conjunctival surface. The significant genetic diversity of bacterial isolates found in the aqueous humor samples after surgery denoted the possibility of anterior chamber contamination during phacoemulsification by bacteria not only from conjunctival surface but also from different sources related to surgical environment. Copyright © 2017 Elsevier B.V. All rights reserved.

Preliminary observation of refractive cataract surgery assisted by femtosecond laser

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Xiao-Li Wang

2015-12-01

Full Text Available AIM:To compare the differences of visual acuity and corneal astigmatism postoperatively between conventional refractive cataract surgery and that assisted by femtosecond laser.METHODS:Sixty patients(60 eyeswith age-related cataract and cornea astigmatism were divided into femtosecond group and conventional group randomly or voluntarily. The flat shaft, steep shaft and diopter of corneal astigmatism in patients in femtosecond group were inputted into the online vector calculators to get the location and width of the incision. Then femtosecond laser was used to make corneal releasing incision, the main and auxiliary incision. Phacoemulsification and aspheric multifocal intraocular lens implantation were undergone. Patients in conventional group received full-thickness relaxing incision by cornea paracentesis knife at the steepest meridian axis during phacoemulsification. Then aspheric multifocal intraocular lenses were implanted. Uncorrected distance visual acuity(UCDVA, uncorrected near visual acuity(UCNVAand cornea astigmatism were observed at 1d,1wk and 1mo postoperative. RESULTS:UCVA of patients in both groups was improved after the surgeries. UCDVA and UCNVA of femtosecond group were higher than those of conventional group, while the cornea astigmatism of femtosecond group was lower than that of conventional group.CONCLUSION:Refractile cataract surgery assisted by femtosecond laser canoffer better visual quality than conventional refractive cataract surgery because of lower cornea astigmatism and better visual acuity.

A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

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Hamid Fesharaki

2012-01-01

Conclusions: As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

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Chen, Ming; Chen, Mindy

2010-11-12

Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.

Effects of genipin corneal crosslinking in rabbit corneas.

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Avila, Marcel Y; Narvaez, Mauricio; Castañeda, Juan P

2016-07-01

To evaluate the effect of genipin, a natural crosslinking agent, in rabbit eyes. Department of Ophthalmology, Universidad Nacional de Colombia Centro de Tecnologia Oftalmica, Bogotá, Colombia. Experimental study. Ex vivo rabbit eyes (16; 8 rabbits) were treated with genipin 1.00%, 0.50%, and 0.25% for 5 minutes with a vacuum device to increase corneal permeability. Penetration was evaluated using Scheimpflug pachymetry (Pentacam). In the in vivo model (20 rabbits; 1 eye treated, 1 eye with vehicle), corneas were crosslinked with genipin as described. Corneal curvature, corneal pachymetry, and intraocular pressure (IOP) assessments as well as slitlamp examinations were performed 0, 7, 30, and 60 days after treatment. In the ex vivo model, Scheimpflug pachymetry showed deep penetration in the rabbit corneas with an increase in corneal density and a dose-dependent relationship. Corneal flattening was observed in treated eyes (mean 4.4 diopters ± 0.5 [SD]) compared with the control eyes. Pachymetry and IOP were stable in all evaluations. No eye showed toxicity in the anterior chamber or in the lens. Corneal crosslinking induced by genipin produced significant flattening of the cornea with no toxicity in rabbit eyes. This crosslinking could be useful in the treatment of corneal ectasia and in the modification of corneal curvature. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems [Corrigendum

OpenAIRE

2015-01-01

Chen M, Anderson E, Hill G, et al. Clin Ophthalmol. 2015;9:1367–1372.  On page 1367, the final sentence of the Introduction which reads:  “The purpose of this study was simply to compare the CDE between the single Centurion and single Infiniti phacoemulsification systems in a larger number of cases to see which one uses less CDE under similar age, sex, and complication rate (P>0.05) among five surgeons in one surgical center.” &a...

Airbag induced corneal ectasia.

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Mearza, Ali A; Koufaki, Fedra N; Aslanides, Ioannis M

2008-02-01

To report a case of airbag induced corneal ectasia. Case report. A patient 3 years post-LASIK developed bilateral corneal ectasia worse in the right eye following airbag deployment in a road traffic accident. At last follow up, best corrected vision was 20/40 with -4.00/-4.00 x 25 in the right eye and 20/25 with -1.25/-0.50 x 135 in the left eye. This is a rare presentation of trauma induced ectasia in a patient post-LASIK. It is possible that reduction in biomechanical integrity of the cornea from prior refractive surgery contributed to this presentation.

Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation.

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Kim, Kyoung Nam; Lee, Sung Bok; Lee, Yeon Hee; Lee, Jong Joo; Lim, Hyung Bin; Kim, Chang-Sik

2016-07-01

To evaluate changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve (AGV) implantation. This study was retrospective and observational case series. Patients with refractory glaucoma who underwent AGV implantation and were followed >5 years were consecutively enrolled. We reviewed the medical records, including the results of central corneal specular microscopy. Of the 127 enrolled patients, the annual change in ECD (%) was determined using linear regression for 72 eyes evaluated at least four times using serial specular microscopic examination and compared with 31 control eyes (fellow glaucomatous eyes under medical treatment). The main outcome measures were cumulative risk of corneal decompensation and differences in the ECD loss rates between subjects and controls. The mean follow-up after AGV implantation was 43.1 months. There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time and statistical significance compared with control eyes disappeared after 2 years postoperatively: -10.7% from baseline to 1 year (p<0.01), -7.0% from 1 year to 2 years (p=0.037), -4.2% from 2 years to 3 years (p=0.230) and -2.7% from 3 years to the final follow-up (p=0.111). In case of uncomplicated AGV implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation. The ECD loss was statistically greater in eyes with AGV than in control eyes without AGV, but the difference was significant only up to 2 years post surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Corneal manifestations in systemic diseases

OpenAIRE

Zarranz-Ventura, J.; Nova, E. De; Moreno-Montañés, J.

2008-01-01

Un gran número de enfermedades sistémicas presentan manifestaciones corneales dentro de su espectro de enfermedad. El estudio detallado de todos los cuadros que asocian patología corneal resulta inabarcable, por ello se presentan las enfermedades más prevalentes o características. Este estudio contempla las enfermedades pulmonares y conectivopatías (colagenosis, enfermedades reumatológicas y enfermedades inflamatorias idiopáticas), las enfermedades dermatológicas, cardiovasculares, hematológi...

Acute corneal hydrops in keratoconus

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Prafulla K Maharana

2013-01-01

Full Text Available Acute corneal hydrops is a condition characterized by stromal edema due to leakage of aqueous through a tear in descemet membrane. The patient presents with sudden onset decrease in vision, photophobia, and pain. Corneal thinning and ectasias combined with trivial trauma to the eye mostly by eye rubbing is considered as the underlying cause. With conservative approach self-resolution takes around 2 to 3 months. Surgical intervention is required in cases of non-resolution of corneal edema to avoid complications and for early visual rehabilitation. Intracameral injection of air or gas such as perflouropropane is the most common surgical procedure done. Recent investigative modality such as anterior segment optical coherence tomography is an extremely useful tool for diagnosis, surgical planning, and postoperative follow up. Resolution of hydrops may improve the contact lens tolerance and visual acuity but most cases require keratoplasty for visual rehabilitation.

Spontaneous Healing of Corneal Perforation after Temporary Discontinuation of Erlotinib Treatment

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Naoyuki Morishige

2014-01-01

Full Text Available Purpose: To report a case of corneal perforation associated with oral administration of erlotinib and its spontaneous healing after temporary discontinuation of drug treatment. Case Report: A 65-year-old man with metastatic lung cancer was treated with erlotinib (150 mg/day, a specific tyrosine kinase inhibitor of the epidermal growth factor receptor. He was referred to our corneal service for the treatment of bilateral corneal disorders, diagnosed with mild aqueous-deficient dry eye, and treated by insertion of punctal plugs. His corneal epithelial disorders initially improved, but subsequently worsened, as manifested by the development of bilateral corneal ulceration with corneal perforation in the right eye. The oral administration of erlotinib was interrupted in preparation for tectonic keratoplasty, but 2 days later the corneal perforation of the right eye and the bilateral epithelial defects had healed spontaneously. Treatment with erlotinib was resumed at half the initial dose, and the cornea of both eyes has remained apparently healthy. Discussion: Erlotinib may be secreted into tear fluid and thereby adversely affect the corneal epithelium. The development of corneal epithelial disorders in patients receiving this drug may be reversed by reducing its dose.

Management of corneal bee sting

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Razmjoo H

2011-12-01

Full Text Available Hassan Razmjoo1,2, Mohammad-Ali Abtahi1,2,4, Peyman Roomizadeh1,3, Zahra Mohammadi1,2, Seyed-Hossein Abtahi1,3,41Medical School, Isfahan University of Medical Sciences (IUMS; 2Ophthalmology Ward, Feiz Hospital, IUMS; 3Isfahan Medical Students Research Center (IMSRC, IUMS; 4Isfahan Ophthalmology Research Center (IORC, Feiz Hospital, IUMS, Isfahan, IranAbstract: Corneal bee sting is an uncommon environmental eye injury that can result in various ocular complications with an etiology of penetrating, immunologic, and toxic effects of the stinger and its injected venom. In this study we present our experience in the management of a middle-aged male with a right-sided deep corneal bee sting. On arrival, the patient was complaining of severe pain, blurry vision with acuity of 160/200, and tearing, which he had experienced soon after the injury. Firstly, we administered conventional drugs for eye injuries, including topical antibiotic, corticosteroid, and cycloplegic agents. After 2 days, corneal stromal infiltration and edema developed around the site of the sting, and visual acuity decreased to 100/200. These conditions led us to remove the stinger surgically. Within 25 days of follow-up, the corneal infiltration decreased gradually, and visual acuity improved to 180/200. We suggest a two-stage management approach for cases of corneal sting. For the first stage, if the stinger is readily accessible or primary dramatic reactions, including infiltration, especially on the visual axis, exist, manual or surgical removal would be indicated. Otherwise, we recommend conventional treatments for eye injuries. Given this situation, patients should be closely monitored for detection of any worsening. If the condition does not resolve or even deteriorates, for the second stage, surgical removal of the stinger under local or generalized anesthesia is indicated.Keywords: bee sting, stinger, cornea, removal, management, surgery

Effects of sodium hyaluronate on ocular inflammatory response and dry eye after phacoemulsification combined with IOL implantation for cataract

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Xing-Guang He

2018-04-01

Full Text Available AIM: To investigate the effect of sodium hyaluronate eye drops on ocular inflammatory response and dry eye after phacoemulsification combined with intraocular lenses(IOLimplantation for age-related cataract. METHODS: The clinical data of age-related cataract patients treated with phacoemulsification combined with IOL implantation in 200 cases(200 eyesof our hospital from June 2016 to July 2017 were retrospectively analyzed. According to the different postoperative application of eye drops they were divided into observation group and control group(100 cases each. The observation group was given sodium hyaluronate eye drops and the control group was given tobramycin dexamethasone eye drops. The results of BUT, FL, proteins concentration in aqueous and ocular surface disease index(OSDIscore were compared before and at the first day, the seventh day and the fourteenth day after the operation. And the incidence of conjunctival hyperemia and ciliary hyperemia was compared between 1d after surgery and 14d after surgery. RESULTS: There was no significant difference in OSDI scores between the two groups before and at 1d after surgery(P>0.05. The OSDI score of the two groups was higher than that before the operation on the first, the seventh and the fourteenth day after surgery(PPPP>0.05. The levels of BUT in the two groups were lower than those before operation on the first, the seventh and the fourteenth day after surgery(PPPP>0.05. The levels of FL in the two groups were different from those before operation(PPPPP>0.05; the incidence of conjunctival hyperemia and ciliary hyperemia in the two groups on the fourteenth day after surgery was lower than that on the first day after surgery(PPPPPCONCLUSION: The effect of sodium hyaluronate eye drops on improving dry eye after age-related cataract phacoemulsification combined with IOL implantation is greater than that of tobramycin dexamethasone eye drops, but it is less effective for eye inflammation than

Impact of Facial Conformation on Canine Health: Corneal Ulceration

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Packer, Rowena M. A.; Hendricks, Anke; Burn, Charlotte C.

2015-01-01

Concern has arisen in recent years that selection for extreme facial morphology in the domestic dog may be leading to an increased frequency of eye disorders. Corneal ulcers are a common and painful eye problem in domestic dogs that can lead to scarring and/or perforation of the cornea, potentially causing blindness. Exaggerated juvenile-like craniofacial conformations and wide eyes have been suspected as risk factors for corneal ulceration. This study aimed to quantify the relationship between corneal ulceration risk and conformational factors including relative eyelid aperture width, brachycephalic (short-muzzled) skull shape, the presence of a nasal fold (wrinkle), and exposed eye-white. A 14 month cross-sectional study of dogs entering a large UK based small animal referral hospital for both corneal ulcers and unrelated disorders was carried out. Dogs were classed as affected if they were diagnosed with a corneal ulcer using fluorescein dye while at the hospital (whether referred for this disorder or not), or if a previous diagnosis of corneal ulcer(s) was documented in the dogs’ histories. Of 700 dogs recruited, measured and clinically examined, 31 were affected by corneal ulcers. Most cases were male (71%), small breed dogs (mean± SE weight: 11.4±1.1 kg), with the most commonly diagnosed breed being the Pug. Dogs with nasal folds were nearly five times more likely to be affected by corneal ulcers than those without, and brachycephalic dogs (craniofacial ratio dogs. A 10% increase in relative eyelid aperture width more than tripled the ulcer risk. Exposed eye-white was associated with a nearly three times increased risk. The results demonstrate that artificially selecting for these facial characteristics greatly heightens the risk of corneal ulcers, and such selection should thus be discouraged to improve canine welfare. PMID:25969983

Study on phototherapeutic keratotomy for bacterial corneal lesions in rabbit

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Xin Zhou

2018-05-01

Full Text Available AIM: To study the effect of phototherapeutic keratectomy(PTKon rabbit bacterial corneal ulcer model and explore the clinical potential of this method. METHODS: Totally 48 eyes from all the 24 New Zealand rabbits were inoculated with Staphylococcus aureus and bacterial corneal ulcer model was established successfully. At 1d after inoculation, 48 eyes were given levofloxacin eye drops when corneal ulcer was confirmed. Then slit lamp inspection and optical coherence tomography(OCTwere performed to measure the central corneal ulcer depth. All the rabbits right eyes were treated with PTK, as an observation group, left eyes were not treated as a control group. The eye section were observed by slit lamp and central thickness of corneal ulcer was measured by OCT at 3 and 7d after this operation. Rabbits were sacrificed and the cornea was removed for pathological section 7d later. RESULTS: The corneal ulcers in both groups had a tendency to heal, showing a decrease in ulcer area and smoothness of the surface. There was no significant difference in the depth of corneal ulcer between the observation group and the control group before PTK(t=0.706, P=0.484. The difference between the two groups of eyes at 3 and 7d after PTK was obviously(PCONCLUSION: PTK can effectively cure rabbit Staphylococcus aureus corneal ulcer and promote ulcer wound healing, which may be used for clinical treatment of patients with bacterial corneal lesions.

Crosslinking and corneal cryotherapy in acanthamoeba keratitis -- a histological study.

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Hager, Tobias; Hasenfus, A; Stachon, T; Seitz, B; Szentmáry, N

2016-01-01

Acanthamoeba keratitis is rare, but difficult to treat. Penetrating keratoplasty is performed in therapy-resistant cases. Nevertheless, subsequent recurrences occur in 40 % of the cases. In addition to triple-topical therapy (polyhexamid, propamidinisoethionat, neomycin), treatment alternatives are corneal cryotherapy and/or crosslinking (CXL). The aim of our present histological study was to analyze the persistence of acanthamoebatrophozoites and cysts, the persistence of bacteria, and activation of keratocytes in corneas of acanthamoeba keratitis patients following corneal cryotherapy and/or CXL. We analyzed histologically corneal buttons (from penetrating keratoplasties) of nine patients with acanthamoeba keratitis, following corneal cryotherapy (two patients) or a combination of crosslinking and corneal cryotherapy (seven patients), using haematoxilin–eosin, periodic acid Schiff (PAS), Gram and alpha-smooth muscle actin (alpha-SMA) stainings. Acanthamoeba trophozoites persisted in three corneas after cryotherapy and CXL. Cysts persisted in one of two corneas following corneal cryotherapy and in six of seven corneas after a combination of CXL and cryotherapy. One cornea showed positive Gram staining, but there were no alpha-SMA positive keratocytes in any of the corneas. Crosslinking and corneal cryotherapy have only limited impact on killing of acanthamoeba trophozoites, cysts, or bacteria. Corneal cryotherapy and CXL did not stimulate myofibroblastic transformation of keratocytes.

Corneal topography

DEFF Research Database (Denmark)

Andersen, J.; Koch-Jensen, P.; Østerby, Ole

1993-01-01

The central corneal zone is depicted on keratoscope photographs using a small target aperture and a large object distance. Information on the peripheral area is included by employing a hemispherical target with a dense circular and radial pattern. On a 16 mm (R = 8 mm) reference steel sphere the ...

Evaluation of Macular Thickness by Optical Coherence Tomography After Phacoemulsification Surgery

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Mehmet Tetikoğlu

2014-03-01

Full Text Available Objectives: To evaluate the incidence of cystoid macular edema (CME, its risk factors, and macular changes by optical coherence tomography (OCT after phacoemulsification. Materials and Methods: This study included 99 eyes of 65 patients who underwent phacoemulsification surgery in Okmeydanı Training and Research Hospital, Department of Ophthalmology. Foveal thickness, macular volume, and mean macular thickness were measured by OCT preoperatively and at 1st day, 1st week, 1st, and 3rd months postoperatively. Results: In this study, the incidence of postoperative CME was 3%. The mean central foveal thickness was preoperatively 250.4 (±18.5 μm, and postoperatively was 252.08 (±23.2 μm at 1st day, 261.4 (±27.8 μm at 1st week, 270.6 (±44.4 μm at 1st month, and 265.4 (±41.6 μm at 3rd month. The statistically significant increase in foveal thickness was defined between preoperative and 1st week, 1st month, 3rd month as well as between 1st week, 1st month, and 3rd month (p<0.01. Increase in macular thickness was demonstrated in 44 eyes (44.4% which was most frequently located in the parafoveal region. Intraoperative complications like iris trauma, posterior capsule tear, and vitreous loss were increased risk of CME (p=0.001. Conclusion: Subclinical macular thickness increment begins at 1st week and reaches maximum point at 1st month. Incidence of CME increased in patients who had a complicated cataract surgery, so they should be followed closely by OCT. (Turk J Ophthalmol 2014; 44: 88-91

Prevalence and associated factors of corneal blindness in Ningxia in northwest China

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Xun-Lun Sheng

2014-06-01

Full Text Available AIM:To describe the prevalence and demographic characteristics of corneal blindness in an urban and rural region of Ningxia, located in the northwest part of China.METHODS:A stratified, randomized sampling procedure was employed in the study, including urban and rural area of all age group. Visual acuity, anterior segment and ocular fundus were checked. Related factor of corneal disease, including age, gender, education status, ethnic group, location and occupation, were identified according to uniform customized protocol. An eye was defined to be corneal blindness if the visual acuity was <20/400 due to a corneal disease.RESULTS:Three thousand individuals (1290 from urban area and 1710 from rural area participated in the investigation, with a response rate of 80.380%. The prevalence of corneal blindness was 0.023% in both eyes and 0.733% in at least one eye. The blindness in at least one eye with varied causes was present in 106 participants (3.533% and in bilateral eyes in 34 participants (1.133%. The corneal diseases accounted for 20.754% of blindness in at least one eye and 20.588% of bilateral blindness. The prevalence of corneal disease was higher in older and Han ethnic group, especially those who occupied in agriculture and outdoor work. People with corneal blindness were more likely to be older and lower education. Rural population were more likely to suffer from bilateral corneal blindness than the urban population in ≥59-year group (χ2=6.716, P=0.019. Infectious, trauma and immune corneal disease were the three leading causes of corneal disease. Trauma corneal disease was more likely leading to blindness in one eye. However, infectious and immune corneal diseases make more contribution to the bilateral corneal blindness.CONCLUSION: Corneal blindness is a significant burden of in Ningxia population, encompassing a variety of corneal infections and trauma; the majority of those were avoidable. Health promotion strategies and good

Nanotechnology in corneal neovascularization therapy--a review.

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Gonzalez, Lilian; Loza, Raymond J; Han, Kyu-Yeon; Sunoqrot, Suhair; Cunningham, Christy; Purta, Patryk; Drake, James; Jain, Sandeep; Hong, Seungpyo; Chang, Jin-Hong

2013-03-01

Nanotechnology is an up-and-coming branch of science that studies and designs materials with at least one dimension sized from 1-100 nm. These nanomaterials have unique functions at the cellular, atomic, and molecular levels. The term "nanotechnology" was first coined in 1974. Since then, it has evolved dramatically and now consists of distinct and independent scientific fields. Nanotechnology is a highly studied topic of interest, as nanoparticles can be applied to various fields ranging from medicine and pharmacology, to chemistry and agriculture, to environmental science and consumer goods. The rapidly evolving field of nanomedicine incorporates nanotechnology with medical applications, seeking to give rise to new diagnostic means, treatments, and tools. Over the past two decades, numerous studies that underscore the successful fusion of nanotechnology with novel medical applications have emerged. This has given rise to promising new therapies for a variety of diseases, especially cancer. It is becoming abundantly clear that nanotechnology has found a place in the medical field by providing new and more efficient ways to deliver treatment. Ophthalmology can also stand to benefit significantly from the advances in nanotechnology research. As it relates to the eye, research in the nanomedicine field has been particularly focused on developing various treatments to prevent and/or reduce corneal neovascularization among other ophthalmologic disorders. This review article aims to provide an overview of corneal neovascularization, currently available treatments, and where nanotechnology comes into play.

Nanotechnology in Corneal Neovascularization Therapy—A Review

Science.gov (United States)

Gonzalez, Lilian; Loza, Raymond J.; Han, Kyu-Yeon; Sunoqrot, Suhair; Cunningham, Christy; Purta, Patryk; Drake, James; Jain, Sandeep; Hong, Seungpyo

2013-01-01

Abstract Nanotechnology is an up-and-coming branch of science that studies and designs materials with at least one dimension sized from 1–100 nm. These nanomaterials have unique functions at the cellular, atomic, and molecular levels.1 The term “nanotechnology” was first coined in 1974.2 Since then, it has evolved dramatically and now consists of distinct and independent scientific fields. Nanotechnology is a highly studied topic of interest, as nanoparticles can be applied to various fields ranging from medicine and pharmacology, to chemistry and agriculture, to environmental science and consumer goods.3 The rapidly evolving field of nanomedicine incorporates nanotechnology with medical applications, seeking to give rise to new diagnostic means, treatments, and tools. Over the past two decades, numerous studies that underscore the successful fusion of nanotechnology with novel medical applications have emerged. This has given rise to promising new therapies for a variety of diseases, especially cancer. It is becoming abundantly clear that nanotechnology has found a place in the medical field by providing new and more efficient ways to deliver treatment. Ophthalmology can also stand to benefit significantly from the advances in nanotechnology research. As it relates to the eye, research in the nanomedicine field has been particularly focused on developing various treatments to prevent and/or reduce corneal neovascularization among other ophthalmologic disorders. This review article aims to provide an overview of corneal neovascularization, currently available treatments, and where nanotechnology comes into play. PMID:23425431

Ultrastructural morphology and morphometry of the normal corneal endothelium of adult crossbred pig Morfologia ultraestrutural e morfometria do endotélio corneal normal de suínos adultos mestiços

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Lynda Jhailú Tamayo-Arango

2009-02-01

Full Text Available Corneal endothelium constitutes a monolayer of polygonal cells. The integrity and health of this layer are essential for the maintenance of normal corneal transparency. This study reported by the first time in a detailed way the ultrastructural morphology and morphometry of the corneal endothelium in normal adult crossbred pigs by using scanning electron microscopy (SEM. A regular pattern of polygonal cells, with predominantly hexagonal cells and clear cell borders, was observed. An oval nucleus that bulges in the centre of the cell, cilia (2-4 in a few peripheral cells, openings of the pinocytotic vesicles, microvilli, borders bars and interdigitated cell borders were observed. The mean endothelial cell area was significantly higher (PO endotélio corneal é uma monocamada de células poligonais. A integridade e saúde dessa camada são essenciais para a manutenção da transparência corneal normal. Este estudo reportou pela primeira vez, de forma detalhada, a morfologia ultra-estrutural e a morfometria do endotélio corneal de suínos adultos mestiços à microscopia eletrônica de varredura (MEV. A superfície endothelial corneal apresentou um padrão regular de células poligonais, com predomínio da forma hexagonal e de bordas celulares nítidas. O núcleo foi observado como protuberância arredondada no centro da célula. Também foram observados os cílios (2-4 em apenas algumas células da região periférica da córnea, as aberturas das vesículas pinocitóticas na proximidade dos cílios, as microvilosidades, as varas da borda e as bordas celulares em formato de zigzag. A área celular média foi significativamente maior (P<0,05 no centro da córnea do que na periferia, com um coeficiente de variação menor no centro da córnea. A densidade celular média foi significativamente maior na periferia (P<0,05 e 43,9% maior que os dados reportados por outros autores na microscopia especular, o que demonstra o efeito da retração celular

Corneal Biomechanical Properties after FS-LASIK with Residual Bed Thickness Less Than 50% of the Original Corneal Thickness

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Haixia Zhang

2018-01-01

Full Text Available Background. The changes in corneal biomechanical properties after LASIK remain an unknown but important topic for surgical design and prognostic evaluation. This study aims to observe the postoperative corneal biomechanical properties one month after LASIK with amount of corneal cutting (ACC greater than 50% of the central corneal thickness (CCT. Methods. FS-LASIK was performed in 10 left rabbit eyes with ACC being 60% (L60 and 65% (L65 of the CCT, while the right eyes (R were the control. After 4 weeks, rabbits were executed and corneal strip samples were prepared for uniaxial tensile tests. Results. At the same strain, the stresses of L65 and L60 were larger than those of R. The elastic moduli of L60 and L65 were larger than those of R when the stress was 0.02 MPa, while they began to be less than those of R when stress exceeds the low-stress region. After 10 s relaxation, the stress of specimens L65, L60, and R increased in turn. Conclusion. The elastic moduli of the cornea after FS-LASIK with ACC greater than 50% of the CCT do not become less under normal rabbit IOP. The limit stress grows with the rise of ACC when relaxation becomes stable.

The Role of Limbal Epithelial Stem Cells in Regulating Corneal (Lymphangiogenic Privilege and the Micromilieu of the Limbal Niche following UV Exposure

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M. Notara

2018-01-01

Full Text Available The cornea is a clear structure, void of blood, and lymphatic vessels, functioning as our window to the world. Limbal epithelial stem cells, occupying the area between avascular cornea and vascularized conjunctiva, have been implicated in tissue border maintenance, preventing conjunctivalisation and propagation of blood and lymphatic vessels into the cornea. Defects in limbal epithelial stem cells are linked to corneal neovascularisation, including lymphangiogenesis, chronic inflammation, conjunctivalisation, epithelial abnormalities including the presence of goblet cells, breaks in Bowman’s membrane, persistent epithelial defects and ulceration, ocular surface squamous neoplasia, lipid keratopathy, pain, discomfort, and compromised vision. It has been postulated that pterygium is an example of focal limbal deficiency. Previous reports showing changes occurring in limbal epithelium during pterygium pathogenesis suggest that there is a link to stem cell damage. In this light, pterygium can serve as a model disease of UV-induced stem cell damage also characterised by corneal blood and lymphangiogenesis. This review focuses on the role of corneal and limbal epithelial cells and the stem cell niche in maintaining corneal avascularity and corneal immune privilege and how this may be deregulated following UV exposure. We present an overview of the PUBMED literature in the field as well as recent work from our laboratories.

Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis.

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Jianping Liu

Full Text Available To evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT and best corrected visual acuity (BCVA in both diabetic patients without diabetic retinopathy (DR and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR.Potential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD and 95% confidence interval (CI for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model.A total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95%CI, -1.230 to -0.399, 3 months (SMD, -0.565; 95%CI, -0.927 to -0.202 and 6 months (SMD, -0.458; 95%CI, -0.739 to -0.177 in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95%CI, -2.433 to 0.021and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95%CI, -1.252 to 0.182 and 6 months (SMD, -1.181; 95%CI, -2.625 to 0.263 in diabetic patients without DR.BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95%CI, 0.251 to 2.047; and SMD,1.349; 95%CI, 0.264 to 2.434, respectively and 6 months (SMD, 1.295; 95%CI, 0.494 to 2.096; and SMD, 2.146; 95%CI, 0.172 to 4.120, respectively in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable.Uncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR

Application of capsular tension ring combined with iris hooks in phacoemulsification of traumatic cataract with lens subluxation

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Li-Gang Li

2015-07-01

Full Text Available AIM: To evaluate the clinical efficacy and safety of capsular tension ring(CTRcombined with iris hooks in eyes with large traumatic zonular dialysis or weakness that underwent micro-incision coaxial phacoemulsification with posterior chamber(PCintraocular lens(IOLimplantation. METHODS: This prospective study was carried on 21 patients(21 eyeswith traumatic cataract and traumaticzonular dialysis(RESULTS: The mean follow-up period was 3～12mo. No serious postoperative complication was found. BCVA in our cases: 0.8 in 5 eyes. IOPs were in normal range too. The IOLs in 20 eyes remained the required position to the final follow-up examination except one eye in which the PC IOL was dislocated into vitreous cavity due to a postoperative spontaneity PCR, and in which vitrectomy and IOL suture fixation was performed.CONCLUSION: In cases of cataract associated with traumatic zonular dialysis(<180°, by setting the rational parameters of phacoemulsification, the CTR and iris hooks are found to be efficient in preventing IOL decentration and reducing operation complication. In our cases, the CTR combined with iris hooks is relatively safe application.

Temporary corneal stem cell dysfunction after radiation therapy

International Nuclear Information System (INIS)

Hiroshi, Fujishima; Kazuo, Tsubota

1996-01-01

Radiation therapy can cause corneal and conjuctival abnormalities that sometimes require surgical treatment. Corneal stem cell dysfunction is described, which recovered after the cessation of radiation. Methods - A 44-year-old man developed a corneal epithelial abnormality associated with conjuctival and corneal inflammation following radiation therapy for maxillary cancer. Examination of brush cytology samples showed goblet cells in the upper and lower parts of the cornea, which showed increased fluorescein permeability, and intraepithelial lymphocytes. Impression cytology showed goblet cells in the same part of the cornea. Specular microscopy revealed spindle type epithelial cells. Patient follow up included artificial tears and an antibiotic ophthalmic ointment. The corneal abnormalities resolved after 4 months with improved visual acuity without any surgical intervention, but the disappearance of the palisades of Vogt did not recover at 1 year after radiation. Radiation therapy in this patient caused temporary stem cell dysfunction which resulted in conjunctivalisation in a part of the cornea. Although limbal stem cell function did not fully recover, this rare case suggested that medical options should be considered before surgery. (Author)

Comparison of phacoemulsification parameters effect on macular thickness changes after uneventful phacoemulsification in diabetic and non-diabetic patients

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Ayse Gul Kocak Altintas

2016-02-01

Full Text Available AIM: To evaluate the effect of phacoemulsification(phacoparameters in micropulse phaco-tecnology with chamber stabilization environment(CASEand increased control and efficiency(ICEmode on central foveal thickness(CFTchanges after uneventful cataract surgery in normal and diabetic patients without retinopathy.METHODS: In this prospective study a total of 120 patients consist of 60 patients with type 2 diabetes mellitus as a diabetic group(DGwithout retinopathy and 60 normal subjects as a control group(CGwho underwent uneventful phaco were evaluated. Intraoperative phacoemulsification parameters including phaco time(PT, and effective phaco time(EPTwere recorded. The CFT measurements were performed preoperatively, at 1 and 3mo postoperatively. The CFT differences were calculated in each exam.RESULTS:The mean PT in DG was 1.40±0.43min and it was 1.44±0.32min in CG, the difference was not significant(P=0.85. The mean EPT was 20.12±8.82s and 19.24±9.02s in DG and CG respectively which was statistically insignificant(P=0.964. The mean preoperative CFT was 218.4±12.0 μm in DG and 222.1±16.6 μm in CG which was not statistically different(P=0.168. The mean increment of CFT in DG was 30.3±37.2 μm at 1mo postoperatively, while it was 13.1±12.5 μm in CG. Even the CFT increments were significant in both groups at 1mo postoperatively, it was statistically higher in DG than that of CG(P=0.001. The average CFT increment at 3mo postoperatively comparing to preoperative level was 12.5±12.4 μm and 4.6±9.7 μm in DG and CG respectively. The increment of CFT was significantly higher in DG than that of CG(P=0.00. But the comparison of the mean CFTs changes from postoperative 1mo and 3mo in both DG and CG, significant decrements were observed in each group(P=0.00 and P=0.03 respectively.CONCLUSION: The significant increment of CFT following uneventful phaco. With the similar phaco parameters were observed in both normal and diabetic subjects. The CFT

Preliminary observation about anterior capsular changes in different patients after cataract phacoemulsification

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Min Wang

2013-09-01

Full Text Available AIM: To compare changes of anterior capsular opening size between complicated and simple cataract patients who underwent phacoemulsification and foldable IOL implantation.METHODS:Patients complicated with high myopia, primary angle-closure glaucoma(PACG, diabetic cataract and simple cataract(control groupwere selected, 25 case in each group. All patients accepted phacoemulsification by the doctor with operation experience of more than 5 000 cases, and the same 1-piece hydrophilic acrylic IOL was implanted without any complicated happened. The measured value about anterior capsular area by Image-pro plus 6.0 was greater than 23mm2. Every patient was checked regularly through dilated pupil, take photos by slit-lamp camera and area was measured after operation 1 week, 1 month, 3 and 6 months, then to record the biological changes about anterior capsular in 4 groups.RESULTS: The average anterior capsular area in 4 groups 1 week after operation had no difference(P>0.05; No difference was found between simple and complicated high myopia group 6 months after operation(P>0.05. Capsule contraction was observed in complicated POAG group 3 months after operation and in diabetes mellitus group 6 months postoperatively, the average anterior capsular area become smaller than 1 week postoperatively(PCONCLUSION: Cataract patients who complicated PACG or diabetes mellitus maybe the high-risk groups, capsule contraction will be happened 1 month after operation. For high-risk groups, we should prolong the follow-up time, enrich the observation data, and provide the clinical basis for reasonable and preventive intervention.

Effects of Silicone Hydrogel Contact Lens Application on Corneal High-order Aberration and Visual Guality in Patients with Corneal Opacities

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Sevda Aydın Kurna

2012-03-01

Full Text Available Pur po se: Evaluation of the corneal high-order aberrations and visual quality changes after application of silicone hydrogel contact lenses in patients with corneal opacities due to various etiologies. Ma te ri al and Met hod: Fifteen eyes of 13 patients with corneal opacities were included in the study. During the ophthalmologic examination before and after contact lens application, visual acuity was measured with Snellen acuity chart and contrast sensitivity - with Bailey-Lowie Charts in letters. Aberrations were measured with corneal aberrometer (NIDEK Magellan Mapper under a naturally dilated pupil. Spherical aberration, coma, trefoil, irregular astigmatism and total high-order root mean square (RMS values were recorded. Measurements were repeated with balafilcon A lenses (PureVision 2 HD, B&L on all patients. Re sults: Patient age varied between 23 and 50 years. Two eyes had subepithelial infiltrates due to adenoviral keratitis, 1 had nebulae due to previous infections or trauma, and 2 had Salzmann’s nodular degeneration. We observed a mean increase of 1 line in visual acuity and 5 letters in contrast sensitivity with contact lenses versus glasses in the patients. Mean RMS values of spherical aberration, irregular astigmatism and total high-order aberrations decreased significantly with contact lenses. Dis cus si on: Silicone hydrogel soft contact lenses may improve visual quality by decreasing the corneal aberrations in patients with corneal opacities. (Turk J Ophthalmol 2012; 42: 97-102

Altered corneal biomechanical properties in children with osteogenesis imperfecta.

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Lagrou, Lisa M; Gilbert, Jesse; Hannibal, Mark; Caird, Michelle S; Thomas, Inas; Moroi, Sayoko E; Bohnsack, Brenda L

2018-04-07

To evaluate biomechanical corneal properties in children with osteogenesis imperfecta (OI). A prospective, observational, case-control study was conducted on children 6-19 years of age diagnosed with OI. Patients with OI and healthy control subjects underwent complete ophthalmic examinations. Additional tests included Ocular Response Analyzer (ORA) and ultrasonic pachymetry. Primary outcomes were central corneal thickness (CCT), corneal hysteresis (CH), and corneal resistance factor (CRF). Intraocular pressure (IOP) was measured directly by either iCare or Goldmann applanation and indirectly by the ORA (Goldmann-correlated and corneal-compensated IOP). Statistically significant differences between OI and control groups were determined using independent samples t test. A total of 10 of 18 OI cases (mean age, 13 ± 4.37 years; 8 males) and 30 controls (mean age, 12.76 ± 2.62 years; 16 males) were able to complete the corneal biomechanics and pachymetry testing. Children with OI had decreased CH (8.5 ± 1.0 mm Hg vs 11.6 ± 1.2 mm Hg [P < 0.001]), CRF (9.0 ± 1.9 mm Hg vs 11.5 ± 1.5 [P < 0.001]) and CCT (449.8 ± 30.8 μm vs 568 ± 47.6 μm [P < 0.001]) compared to controls. The corneal-compensated IOP was significantly higher in OI cases (18.8 ± 3.1 mm Hg) than in controls (15.0 ± 1.6 mm Hg, P < 0.004), but there was no significant difference in Goldmann-correlated IOP (16.3 ± 4.2 mm Hg vs 15.8 ± 2.2 mm Hg). Collagen defects in OI alter corneal structure and biomechanics. Children with OI have decreased CH, CRF, and CCT, resulting in IOPs that are likely higher than measured by tonometry. These corneal alterations are present at a young age in OI. Affected individuals should be routinely screened for glaucoma and corneal pathologies. Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Regulation of corneal stroma extracellular matrix assembly.

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Chen, Shoujun; Mienaltowski, Michael J; Birk, David E

2015-04-01

The transparent cornea is the major refractive element of the eye. A finely controlled assembly of the stromal extracellular matrix is critical to corneal function, as well as in establishing the appropriate mechanical stability required to maintain corneal shape and curvature. In the stroma, homogeneous, small diameter collagen fibrils, regularly packed with a highly ordered hierarchical organization, are essential for function. This review focuses on corneal stroma assembly and the regulation of collagen fibrillogenesis. Corneal collagen fibrillogenesis involves multiple molecules interacting in sequential steps, as well as interactions between keratocytes and stroma matrix components. The stroma has the highest collagen V:I ratio in the body. Collagen V regulates the nucleation of protofibril assembly, thus controlling the number of fibrils and assembly of smaller diameter fibrils in the stroma. The corneal stroma is also enriched in small leucine-rich proteoglycans (SLRPs) that cooperate in a temporal and spatial manner to regulate linear and lateral collagen fibril growth. In addition, the fibril-associated collagens (FACITs) such as collagen XII and collagen XIV have roles in the regulation of fibril packing and inter-lamellar interactions. A communicating keratocyte network contributes to the overall and long-range regulation of stromal extracellular matrix assembly, by creating micro-domains where the sequential steps in stromal matrix assembly are controlled. Keratocytes control the synthesis of extracellular matrix components, which interact with the keratocytes dynamically to coordinate the regulatory steps into a cohesive process. Mutations or deficiencies in stromal regulatory molecules result in altered interactions and deficiencies in both transparency and refraction, leading to corneal stroma pathobiology such as stromal dystrophies, cornea plana and keratoconus. Copyright © 2014 Elsevier Ltd. All rights reserved.

Dextran Preserves Native Corneal Structure During Decellularization.

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Lynch, Amy P; Wilson, Samantha L; Ahearne, Mark

2016-06-01

Corneal decellularization has become an increasingly popular technique for generating scaffolds for corneal regeneration. Most decellularization procedures result in tissue swelling, thus limiting their application. Here, the use of a polysaccharide, dextran, to reduce swelling and conserve the native corneal structure during decellularization was investigated. Corneas were treated with 1% Triton X-100, 0.5% sodium dodecyl sulfate, and nucleases under constant rotation followed by extensive washing. To reduce swelling, decellularization solutions were supplemented with 5% dextran either throughout the whole decellularization process or during the washing cycles only. Quantitative analysis of DNA content showed a 96% reduction after decellularization regardless of the addition of dextran. Dextran resulted in a significant reduction in swelling from 3.85 ± 0.43 nm without to 1.94 ± 0.29-2.01 ± 0.37 nm (p dextran must be present throughout the decellularization protocol to preserve the native corneal architecture, anisotropy analysis demonstrated comparable results (0.22 ± 0.03) to the native cornea (0.24 ± 0.02), p > 0.05. Dextran can counteract the detrimental effects of decellularizing agents on the biomechanical properties of the tissue resulting in similar compressive moduli (mean before decellularization: 5.40 ± 1.18 kPa; mean after decellularization with dextran: 5.64 ± 1.34 kPa, p > 0.05). Cells remained viable in the presence of decellularized scaffolds. The findings of this study indicate that dextran not only prevents significant corneal swelling during decellularization but also enhances the maintenance of the native corneal ultrastructure.

Analysis of corneal topography in patients with pure microphthalmia in Eastern China.

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Hu, Pei-Hong; Gao, Gui-Ping; Yu, Yao; Pei, Chong-Gang; Zhou, Qiong; Huang, Xin; Zhang, Ying; Shao, Yi

2015-12-01

To determine the typical corneal changes in pure microphthalmia using a corneal topography system and identify characteristics that may assist in early diagnosis. Patients with pure microphthalmia and healthy control subjects underwent corneal topography analysis (Orbscan IIZ® Corneal Topography System; Bausch and Lomb, Bridgewater, NJ, USA) to determine degree of corneal astigmatism (mean A), simulation of corneal astigmatism (sim A), mean keratometry (mean K), simulated keratometry (sim K), irregularities in the 3 - and 5-mm zone, and mean thickness of nine distinct corneal regions. Patients with pure microphthalmia (n = 12) had significantly higher mean K, sim K, mean A, sim A, 3.0 mm irregularity and 5.0 mm irregularity, and exhibited significantly more false keratoconus than controls (n = 12). There was a significant between-group difference in the morphology of the anterior corneal surface and the central curvature of the cornea. Changes in corneal morphology observed in this study could be useful in borderline situations to confirm the diagnosis of pure microphthalmia. © The Author(s) 2015.

Congenital Corneal Anesthesia and Neurotrophic Keratitis: Diagnosis and Management

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Flavio Mantelli

2015-01-01

Full Text Available Neurotrophic keratitis (NK is a rare degenerative disease of the cornea caused by an impairment of corneal sensory innervation, characterized by decreased or absent corneal sensitivity resulting in epithelial keratopathy, ulceration, and perforation. The aetiopathogenesis of corneal sensory innervation impairment in children recognizes the same range of causes as adults, although they are much less frequent in the pediatric population. Some extremely rare congenital diseases could be considered in the aetiopathogenesis of NK in children. Congenital corneal anesthesia is an extremely rare condition that carries considerable diagnostic and therapeutic problems. Typically the onset is up to 3 years of age and the cornea may be affected in isolation or the sensory deficit may exist as a component of a congenital syndrome, or it may be associated with systemic somatic anomalies. Accurate diagnosis and recognition of risk factors is important for lessening long-term sequelae of this condition. Treatment should include frequent topical lubrication and bandage corneal or scleral contact lenses. Surgery may be needed in refractory cases. The purpose of this review is to summarize and update data available on congenital causes and treatment of corneal hypo/anesthesia and, in turn, on congenital NK.

Analysis of corneal esthesia in patients undergoing photorefractive keratectomy

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Elmar Torres Neto

2015-12-01

Full Text Available ABSTRACT Purpose: To quantitatively analyze corneal esthesia in patients undergoing photorefractive keratectomy (PRK surgery. Methods: Forty-five patients selected for PRK in one eye underwent corneal esthesia using a Cochet-Bonnet esthesiometer preoperatively and 30 and 90 days postoperatively. Patients with a refractive diopter error of 4 or greater received intraoperative 0.02% mitomycin C for 20 s. Results: Twenty-four (53.3% of the 45 eyes received intraoperative 0.02% mitomycin. Decreased sensitivity was observed on postoperative day 30. By postoperative day 90, corneal esthesia had normalized but remained 14.9% lower than preoperative levels. In the mitomycin group, no recovery of corneal esthesia to normal sensitivity levels was observed. The mean esthesiometer level was 39.2 mm on postoperative day 90 (P<0.001. Conclusions: The results of the present study demonstrate recovery of corneal esthesia to normal levels at 90 days postoperatively in patients who did not receive mitomycin C. In patients administered mitomycin C, a 23.59% reduction in the corneal touch threshold was observed compared with preoperative levels indicating a failure of recovery to normal levels.

Corneal conjunctivalization management with high Dk RGP contact lenses.

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Martin, Raul

2009-06-01

To describe the management of corneal conjunctivalization with a high Dk RGP contact lens (CL) fitting. A high Dk RGP CL (Menicon Z-alpha Dk=189, Japan) was fitted, after temporary suspension of CL wear (6 months and 3 weeks), in two patients (a 36-year-old female and a 38-year-old male) who had corneal conjunctivalization secondary to low Dk soft CL wear. Both patients had worn their soft CLs 12-14 h per day without symptoms for the previous 18-20 years. After 9-15 months of high Dk RGP wear, all signs of corneal conjunctivalization had disappeared (corneal vascularization, late fluorescein stain, etc.) and patients wore their RGP CL comfortably. Corneal conjunctivalization was resolved with non-invasive procedures (temporary discontinuation, preservative-free artificial tears and high Dk RGP CL fitting) and thus other treatments (topical or surgical treatments such as limbus transplantation, amniotic membrane transplant or others) were not necessary. Short temporary suspension of CL wear (3 weeks), preservative-free artificial tears and refitting with high oxygen permeability RGP CL may be an alternative for the management of corneal conjunctivalization secondary to CL wear.

Bioactive self-assembled peptide nanofibers for corneal stroma regeneration.

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Uzunalli, G; Soran, Z; Erkal, T S; Dagdas, Y S; Dinc, E; Hondur, A M; Bilgihan, K; Aydin, B; Guler, M O; Tekinay, A B

2014-03-01

Defects in the corneal stroma caused by trauma or diseases such as macular corneal dystrophy and keratoconus can be detrimental for vision. Development of therapeutic methods to enhance corneal regeneration is essential for treatment of these defects. This paper describes a bioactive peptide nanofiber scaffold system for corneal tissue regeneration. These nanofibers are formed by self-assembling peptide amphiphile molecules containing laminin and fibronectin inspired sequences. Human corneal keratocyte cells cultured on laminin-mimetic peptide nanofibers retained their characteristic morphology, and their proliferation was enhanced compared with cells cultured on fibronectin-mimetic nanofibers. When these nanofibers were used for damaged rabbit corneas, laminin-mimetic peptide nanofibers increased keratocyte migration and supported stroma regeneration. These results suggest that laminin-mimetic peptide nanofibers provide a promising injectable, synthetic scaffold system for cornea stroma regeneration. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

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Nauman Ahmad

2012-01-01

Full Text Available Background: Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Methods: Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS. The Student′s t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant. Results: Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively. In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively. Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Conclusion: Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

Atypical Presentation of Iridocorneal Endothelial Syndrome With Band Keratopathy but No Corneal Edema Managed With Descemet Membrane Endothelial Keratoplasty.

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Zygoura, Vasiliki; Lavy, Itay; Verdijk, Robert M; Santander-García, Diana; Baydoun, Lamis; Dapena, Isabel; Melles, Gerrit R J

2018-04-17

To report an unusual presentation of iridocorneal endothelial (ICE) syndrome associated with band keratopathy and its management with ethylenediamine-tetraacetic acid (EDTA) chelation and Descemet membrane endothelial keratoplasty (DMEK). A 57-year-old female patient presented with unilateral progressive painless visual impairment, corneal band keratopathy, and morphological corneal endothelial changes without corneal edema or any previous ophthalmic, medical, or family history. Routine specular and confocal microscopy imaging, as well as biomicroscopy, best-corrected visual acuity, and pachymetry measurements were performed before and after the surgical procedures. Histopathologic and immunohistochemical evaluations of the surgically excised diseased DM-endothelium were performed. Superficial epithelial keratectomy with EDTA chelation was performed. After an initial period of a few months of corneal clearance, the patient presented with recurrence of visually significant band keratopathy. After 1 year, she underwent retreatment with superficial epithelial keratectomy and EDTA chelation, followed by DMEK. Histopathologic and immunohistochemical analysis showed ICE syndrome. Two years after DMEK surgery, the cornea was still clear and band keratopathy had not recurred. To the best of our knowledge, this is the first case in the literature that reports the association of ICE syndrome with band keratopathy. As band keratopathy recurred shortly after EDTA chelation, endothelial keratoplasty (DMEK) may be indicated to successfully treat such cases.

Corneal photoablation in vivo with the erbium:YAG laser: first report

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Jean, Benedikt J.; Bende, Thomas; Matallana, Michael; Kriegerowski, Martin

1995-05-01

As an alternative to far-UV lasers for corneal refractive surgery, the Erbium:YAG laser may be used in TEM00 mode. The resulting gaussian beam profile leads to a certain amount of myopic correction per laser pulse. Although animal data suggest that the clinical outcome should be comparable to the UV-lasers, no human data were available until now. We performed Erbium:YAG laser areal ablation in 5 blind human eyes. In TEM00 mode, the laser parameters were: effective diameter of laser spot equals 3.4 mm, fluence equals 380 mJ/cm2, pulse duration equals 250 microsecond(s) , Repetition rate equals 4 Hz, Number of applied laser pulses equals 15. Four patients with no light perception, one with intact light projection on one eye (some of them scheduled for enucleation) were treated under topical anaesthesia. Patient selection and informed consent were agreed to by the University's independent Ethics Committee. Prior to laser irradiation, corneal epithelium was removed. A postoperative silicone cast of the cornea was analyzed with a confocal laser micro-topometer for the ablation profile. The eyes were treated with antibiotic ointment until the epithelium was closed. Clinical appearance and, where possible, profilometry of the ablated area was observed. The ablation profile in cornea was gaussian shaped with a maximal depth of 30 micrometers . During laser treatment, the corneal surface becomes opaque, clearing in a matter of seconds. Epithelial healing and clinical appearance was similar to excimer laser treatment. However, during the first week, the irradiated area shows subepithelial irregularities, resembling small bubbles, disappearing thereafter.

Pirfenidone nanoparticles improve corneal wound healing and prevent scarring following alkali burn.

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Sushovan Chowdhury

Full Text Available To evaluate the effects of pirfenidone nanoparticles on corneal re-epithelialization and scarring, major clinical challenges after alkali burn.Effect of pirfenidone on collagen I and α-smooth muscle actin (α-SMA synthesis by TGFβ induced primary corneal fibroblast cells was evaluated by immunoblotting and immunocytochemistry. Pirfenidone loaded poly (lactide-co-glycolide (PLGA nanoparticles were prepared, characterized and their cellular entry was examined in primary corneal fibroblast cells by fluorescence microscopy. Alkali burn was induced in one eye of Sprague Dawley rats followed by daily topical treatment with free pirfenidone, pirfenidone nanoparticles or vehicle. Corneal re-epithelialization was assessed daily by flourescein dye test; absence of stained area indicated complete re-epithelialization and the time for complete re-epithelialization was determined. Corneal haze was assessed daily for 7 days under slit lamp microscope and graded using a standard method. After 7 days, collagen I deposition in the superficial layer of cornea was examined by immunohistochemistry.Pirfenidone prevented (P<0.05 increase in TGF β induced collagen I and α-SMA synthesis by corneal fibroblasts in a dose dependent manner. Pirfenidone could be loaded successfully within PLGA nanoparticles, which entered the corneal fibroblasts within 5 minutes. Pirfenidone nanoparticles but not free pirfenidone significantly (P<0.05 reduced collagen I level, corneal haze and the time for corneal re-epithelialization following alkali burn.Pirfenidone decreases collagen synthesis and prevents myofibroblast formation. Pirfenidone nanoparticles improve corneal wound healing and prevent fibrosis. Pirfenidone nanoparticles are of potential value in treating corneal chemical burns and other corneal fibrotic diseases.

Corneal iron ring after hyperopic photorefractive keratectomy.

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Bilgihan, K; Akata, F; Gürelik, G; Adigüzel, U; Akpinar, M; Hasanreisoğlu, B

1999-05-01

To report the incidence and course of corneal iron deposition after hyperopic photorefractive keratectomy (PRK). Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. Between January 1995 and December 1997, 62 eyes had PRK to correct hyperopia. Nine eyes developed corneal iron ring 5 to 8 months (mean 6.25 months +/- 1.3 [SD]) after PRK for hyperopia. The rings persisted during the mean follow-up of 19 +/- 11.09 months. The ring-shaped iron deposition after PRK for hyperopia must be differentiated from the Fleischer ring. Our results suggest that the slitlamp findings of peripheral corneal iron deposition in hyperopic PRK patients correlate with achieved correction.

Corneal collagen crosslinking for keratoconus. A review

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M. M. Bikbov

2014-10-01

Full Text Available Photochemical crosslinking is widely applied in ophthalmology. Its biochemical effect is due to the release of singlet oxygen that promotes anaerobic photochemical reaction. Keratoconus is one of the most common corneal ectasia affecting 1 in 250 to 250 000 persons. Currently, the rate of iatrogenic ectasia following eximer laser refractive surgery increases due to biomechanical weakening of the cornea. Morphologically and biochemically, ectasia is characterized by corneal layers thinning, contact between the stroma and epithelium resulting from Bowman’s membrane rupture, chromatin fragmentation in keratocyte nuclei, phagocytosis, abnormal staining and arrangement of collagen fibers, enzyme system disorders, and keratocyte apoptosis. In corneal ectasia, altered enzymatic processes result in the synthesis of abnormal collagen. Collagen packing is determined by the activity of various extracellular matrix enzymes which bind amines and aldehydes of collagen fiber amino acids. In the late stage, morphological changes of Descemet’s membrane (i.e., rupture and detachment develop. Abnormal hexagonal-shaped keratocytes and their apoptosis are the signs of endothelial dystrophy. The lack of analogs in domestic ophthalmology encouraged the scientists of Ufa Eye Research Institute to develop a device for corneal collagen crosslinking. The parameters of ultraviolet (i.e., wavelength, exposure time, power to achieve the desired effect were identified. The specifics of some photosensitizers in the course of the procedure were studied. UFalink, a device for UV irradiation of cornea, and photosensitizer Dextralink were developed and adopted. Due to the high risk of endothelial damage, this treatment is contraindicated in severe keratoconus (CCT less than 400 microns. Major effects of corneal collagen crosslinking are the following: Young’s modulus (modulus of elasticity increase by 328.9 % (on average, temperature tolerance increase by 5�

[The status quo and expectation of corneal research in China].

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Shi, Weiyun; Xie, Lixin

2014-09-01

In China, corneal disease is currently the second leading cause of blindness. Severe donor shortage, insufficient technique supports and promotion, and the lack of corneal disease specialists due to poor systematic training are all urgent problems to be resolved. The last 5 years have witnessed a considerable progress in basic and clinical researches of corneal disease. Investigations on the pathogenesis and treatment of fungal keratitis have won an international reputation. Results from the study of corneal reconstruction with tissue-engineered and acellular matrix corneas have been tested in clinical trials with good preliminary performance. Moreover, the clinical researches of corneal refractive surgery have kept pace with the latest international progresses. However, Descemet's membrane endothelial keratoplasty needs further promotion, and the development and application of keratoprosthesis remains a blank. Although keratoprosthesis and corneal collagen cross-linking have been widely applied in Europe with satisfactory clinical efficacy, they are still under assessment by China Food and Drug Administration for approval of use.

Cost-effectiveness analysis of cataract surgery with intraocular lens implantation: extracapsular cataract extraction versus phacoemulsification

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Mohd R.A. Manaf

2007-03-01

Full Text Available A randomized single blinded clinical trial to compare the cost-effectiveness of cataract surgery between extracapsular cataract extraction (ECCE and phacoemulsification (PEA was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM from March 2000 until August 2001. The cost of a cataract surgery incurred by hospital, patients and households were calculated preoperatively, one week, two months (for both techniques and six months (for ECCE only. Effectiveness of cataract surgery was assessed using Visual Function 14 (VF-14, quality of life measurement specifically for vision. The cost analysis results from each 50 subjects of ECCE and PEA group showed that average cost for one ECCE after six months post-operation is USD 458 (± USD 72 and for PEA is USD 528 (± USD 125. VF-14 score showed a significant increased after a week, two months and six months post-operation compared to the score before operation for both techniques (p<0.001. However, there was no significant difference between them (p = 0.225. This study indicated that ECCE is more cost effective compared to PEA with cost per one unit increment of VF-14 score of USD 14 compared to USD 20 for PEA. (Med J Indones 2007; 16:25-31 Keywords: cataract, cost-effectiveness, extracapsular cataract extraction, phacoemulsification, visual function 14

Characterization of elasticity and hydration of composite hydrogel based on collagen-iota carrageenan as a corneal tissue engineering

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Rinawati, M.; Triastuti, J.; Pursetyo, K. T.

2018-04-01

The cornea is a refractive element of the eye that serves to continue the stimulation of light into the eye it has a clear, transparent, elastic and relatively thick tissue. Factors caused corneal blindness, are dystrophy, keratoconus, corneal scaring. Hydrogels can be made from polysaccharide derivatives that have gelation properties such as iota carrageenan. Therefore, it is a need to develop composite hydrogel based collagen-iota carragenan as an engineeried corneal tissue with high elasticity and hydration properties. Collagen hydrogel has a maximum water content an has equlibrium up to 40 %, less than the human cornea, 81 % and under normal hydration conditions, the human cornea can transmit 87 % of visible light. In addition, the refractive index on the surface of the cornea with air is 1.375-1.380. Based on this study, it is necessary to conduct research on the development and composition of hydrogel composite collagen-iota carrageen hydrogen based on. The best result was K5 (5:5) treatment, which has the equilibrium water content of 87.07 % and viscosity of 10.7346 Pa.s.

Corynebacterium macginleyi isolated from a corneal ulcer

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Kathryn Ruoff

2010-02-01

Full Text Available We report the isolation of Corynebacterium macginleyi from the corneal ulcer culture of a patient, later enrolled in the Steroids for Corneal Ulcer Trial (SCUT. To our knowledge this is the first published report from North America of the recovery of C. macginleyi from a serious ocular infection.

21 CFR 886.4070 - Powered corneal burr.

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2010-04-01

...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4070 Powered corneal burr. (a) Identification. A powered corneal burr is an AC-powered or battery-powered device that is a motor and drilling tool intended to remove rust rings from the cornea of the eye. (b) Classification. Class I (general controls). When...

Topical administration of orbital fat-derived stem cells promotes corneal tissue regeneration.

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Lin, Ko-Jo; Loi, Mei-Xue; Lien, Gi-Shih; Cheng, Chieh-Feng; Pao, Hsiang-Yin; Chang, Yun-Chuang; Ji, Andrea Tung-Qian; Ho, Jennifer Hui-Chun

2013-06-14

Topical administration of eye drops is the major route for drug delivery to the cornea. Orbital fat-derived stem cells (OFSCs) possess an in vitro corneal epithelial differentiation capacity. Both the safety and immunomodulatory ability of systemic OFSC transplantation were demonstrated in our previous work. In this study, we investigated the safety, therapeutic effect, and mechanism(s) of topical OFSC administration in an extensive alkali-induced corneal wound. Corneal injury was created by contact of a piece of 0.5 N NaOH-containing filter paper on the corneal surface of a male Balb/c mouse for 30 s. The area of the filter paper covered the central 70% or 100% of the corneal surface. OFSCs (2 × 10(5)) in 5 μl phosphate-buffered saline (PBS) were given by topical administration (T) twice a day or by two intralimbal (IL) injections in the right cornea, while 5 μl of PBS in the left cornea served as the control. Topical OFSCs promoted corneal re-epithelialization of both the limbal-sparing and limbal-involved corneal wounds. In the first three days, topical OFSCs significantly reduced alkali-induced corneal edema and stromal infiltration according to a histopathological examination. Immunohistochemistry and immunofluorescence staining revealed that transplanted cells were easily detectable in the corneal epithelium, limbal epithelium and stroma, but only some of transplanted cells at the limbal epithelium had differentiated into cytokeratin 3-expressing cells. OFSCs did not alter neutrophil (Ly6G) levels in the cornea, but significantly reduced macrophage (CD68) infiltration and inducible nitrous oxide synthetase (iNOS) production during acute corneal injury as quantified by a Western blot analysis. Continuous topical administration of OFSCs for seven days improved corneal transparency, and this was accompanied by diffuse stromal engraftment of transplanted cells and differentiation into p63-expressing cells at the limbal area. The therapeutic effect of the

Topical administration of orbital fat-derived stem cells promotes corneal tissue regeneration

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2013-01-01

Introduction Topical administration of eye drops is the major route for drug delivery to the cornea. Orbital fat-derived stem cells (OFSCs) possess an in vitro corneal epithelial differentiation capacity. Both the safety and immunomodulatory ability of systemic OFSC transplantation were demonstrated in our previous work. In this study, we investigated the safety, therapeutic effect, and mechanism(s) of topical OFSC administration in an extensive alkali-induced corneal wound. Methods Corneal injury was created by contact of a piece of 0.5 N NaOH-containing filter paper on the corneal surface of a male Balb/c mouse for 30 s. The area of the filter paper covered the central 70% or 100% of the corneal surface. OFSCs (2 × 105) in 5 μl phosphate-buffered saline (PBS) were given by topical administration (T) twice a day or by two intralimbal (IL) injections in the right cornea, while 5 μl of PBS in the left cornea served as the control. Results Topical OFSCs promoted corneal re-epithelialization of both the limbal-sparing and limbal-involved corneal wounds. In the first three days, topical OFSCs significantly reduced alkali-induced corneal edema and stromal infiltration according to a histopathological examination. Immunohistochemistry and immunofluorescence staining revealed that transplanted cells were easily detectable in the corneal epithelium, limbal epithelium and stroma, but only some of transplanted cells at the limbal epithelium had differentiated into cytokeratin 3-expressing cells. OFSCs did not alter neutrophil (Ly6G) levels in the cornea, but significantly reduced macrophage (CD68) infiltration and inducible nitrous oxide synthetase (iNOS) production during acute corneal injury as quantified by a Western blot analysis. Continuous topical administration of OFSCs for seven days improved corneal transparency, and this was accompanied by diffuse stromal engraftment of transplanted cells and differentiation into p63-expressing cells at the limbal area. The

The Correlation Analysis between Corneal Biomechanical Properties and the Surgically Induced Corneal High-Order Aberrations after Small Incision Lenticule Extraction and Femtosecond Laser In Situ Keratomileusis

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Wenjing Wu

2015-01-01

Full Text Available Background. To investigate the correlation between corneal biomechanics and the surgically induced corneal high-order aberrations (HOAs after small incision lenticule extraction (SMILE and femtosecond laser in situ keratomileusis (FS-LASIK. Methods. A total of 150 right myopic eyes that underwent SMILE or FS-LASIK surgery were included in this retrospective study, 75 eyes in each group. The corneal hysteresis (CH and the corneal resistance factor (CRF with the corneal HOAs of the anterior, posterior, and total cornea were assessed preoperatively and three months postoperatively. Multivariate linear regression was applied to determine the correlations. Results. The preoperative CRF was significantly correlated with the induced 3rd–6th-order HOAs and spherical aberration of the anterior surface and the total cornea after SMILE and FS-LASIK surgeries (P<0.05, postoperatively. The CRF was significantly correlated with the induced vertical coma of the anterior and posterior surfaces and the total cornea after SMILE surgery (P<0.05. There was a significant correlation between the CRF and the induced posterior corneal horizontal coma after FS-LASIK surgery (P=0.013. Conclusions. The corneal biomechanics affect the surgically induced corneal HOAs after SMILE and FS-LASIK surgery, which may be meaningful for screening the patients preoperatively and optimizing the visual qualities postoperatively.

Corneal graft reversal: Histopathologic report of two cases

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Qahtani, Abdullah A.; Alkatan, Hind M.

2014-01-01

Graft reversal is a rare cause for failed PKP. In this case report we are presenting 2 graft failure cases in which the corneal grafts were reversed unintentionally. The onset of signs of graft failure, however was variable. We have included their clinical course and the histopathologic findings of the removed corneal grafts. A total of 6 cases including ours have been reported so far. The aim of this report is to attract the attention of corneal surgeons to an additional rare cause for faile...

Contact lens rehabilitation following repaired corneal perforations

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Titiyal, Jeewan S; Sinha, Rajesh; Sharma, Namrata; Sreenivas, V; Vajpayee, Rasik B

2006-01-01

Background Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. Method Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. Results Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 ± 0.13 while the same with contact lens was 0.58 ± 0.26. All the patients showed an improvement of ≥ 2 lines over spectacles in the snellen's acuity chart with contact lens. Conclusion Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries. PMID:16536877

Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

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Mohammad Zare

2010-01-01

Full Text Available Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results: During this period, 776 eyes of 756 patients (including 504 male subjects with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8% followed by bullous keratopathy (n=90, 11.6%, non-herpetic corneal scars (n=62, 8.0%, infectious corneal ulcers (n=61, 7.9%, previously failed grafts (n=61, 7.9%, endothelial and stromal corneal dystrophies (n=28, 3.6%, and trachoma keratopathy (n=26, 3.3%. Other indications including Terrien′s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%, deep anterior lamellar keratoplasty (n=108, 13.9%, conventional lamellar keratoplasty (n=44, 5.7%, automated lamellar therapeutic keratoplasty (n=8, 1.0%, and Descemet stripping endothelial keratoplasty (n=6, 0.8% in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.

Clinical observation of Artisan iris-clip intraocular lens implantation at stage Ⅰ

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Qing Zhou

2014-09-01

Full Text Available AIM: To observe the clinical efficacy of Artisan iris-clip intraocular lens(IOLimplantation on cataract with a wide range of lens dislocation.METHODS: Twenty-four hospital patients(28 eyesof cataract with lens subluxation by trauma(20 patients, 20 eyesand Marfan's syndrome(4 patients, 8 eyesduring May 2007 to December 2011 were selected. All of them underwent phacoemulsification or an anterior vitrectomy and Artisan iris-clip IOL implantation at stage Ⅰ. Postoperative visual acuity, corneal endothelial cell count, intraocular lens position and postoperative complications were observed. Follow-up time was 6mo.RESULTS:Compared with the preoperative, postoperative best corrected visual acuity improved to varying degrees, visual acuity of 0.1-0.5 was in 20 eyes, 0.5-1.0 in 8 eyes. After followed up 1-6mo, no artificial lens shift, iris inflammation, iris atrophy and corneal decompensation and other complications were observed.CONCLUSION: Cataract surgery with a wide range of lens dislocation is difficult, but as long as surgeons who have a wealth of clinical experience and superb skills, still can carry out phacoemulsification surgery or anterior vitrectomy and Artisan iris-clip IOL implantation and obtain a better outcome.

Clinical correlates of common corneal neovascular diseases:a literature review

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Nizar Saleh Abdelfattah

2015-02-01

Full Text Available A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization, leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far.

The Steroids for Corneal Ulcers Trial

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Srinivasan, Muthiah; Mascarenhas, Jeena; Rajaraman, Revathi; Ravindran, Meenakshi; Lalitha, Prajna; Glidden, David V.; Ray, Kathryn J.; Hong, Kevin C.; Oldenburg, Catherine E.; Lee, Salena M.; Zegans, Michael E.; McLeod, Stephen D.; Lietman, Thomas M.; Acharya, Nisha R.

2013-01-01

Objectives To provide comprehensive trial methods and baseline data for the Steroids for Corneal Ulcers Trial and to present epidemiological characteristics such as risk factors, causative organisms, and ulcer severity. Methods Baseline data from a 1:1 randomized, placebo-controlled, double-masked clinical trial comparing prednisolone phosphate, 1%, with placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and had been taking moxifloxacin for 48 hours. The primary outcome for the trial is best spectacle-corrected visual acuity at 3 months from enrollment. This report provides comprehensive baseline data, including best spectacle-corrected visual acuity, infiltrate size, microbio-logical results, and patient demographics, for patients enrolled in the trial. Results Of 500 patients enrolled, 97% were in India. Two hundred twenty patients (44%) were agricultural workers. Median baseline visual acuity was 0.84 logMAR (Snellen, 20/125) (interquartile range, 0.36-1.7; Snellen, 20/50 to counting fingers). Baseline visual acuity was not significantly different between the United States and India. Ulcers in India had larger infiltrate/scar sizes (P=.04) and deeper infiltrates (P=.04) and were more likely to be localized centrally (P=.002) than ulcers enrolled in the United States. Gram-positive bacteria were the most common organisms isolated from the ulcers (n=366, 72%). Conclusions The Steroids for Corneal Ulcers Trial will compare the use of a topical corticosteroid with placebo as adjunctive therapy for bacterial corneal ulcers. Patients enrolled in this trial had diverse ulcer severity and on average significantly reduced visual acuity at presentation. PMID:21987581

Thermal characterization of phacoemulsification probes operated in axial and torsional modes.

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Zacharias, Jaime

2015-01-01

To analyze temperature increases and identify potential sources of heat generated when sleeved and sleeveless phacoemulsification probes were operated in axial and torsional modes using the Infiniti Vision System with the Ozil torsional handpiece. Phacodynamics Laboratory, Pasteur Ophthalmic Clinic, Santiago, Chile. Experimental study. Two computer-controlled thermal transfer systems were developed to evaluate the contribution of internal metal stress and tip-to-sleeve friction on heat generation during phacoemulsification using axial and torsional ultrasound modalities. Both systems incorporated infrared thermal imaging and used a black-body film to accurately capture temperature measurements. Axial mode was consistently associated with greater temperature increases than torsional mode whether tips were operated with or without sleeves. In tests involving bare tips, axial mode and torsional mode peaked at 51.7°C and 34.2°C, respectively. In an example using sleeved tips in which a 30.0 g load was applied for 1 second, temperatures for axial mode reached 45°C and for torsional mode, 38°C. Friction between the sleeved probe and the incisional wall contributed more significantly to the temperature increase than internal metal stress regardless of the mode used. In all experiments, the temperature increase observed with axial mode was greater than that observed with torsional mode, even when conditions such as power or amplitude and flow rate were varied. Tip-to-sleeve friction was a more dominant source of phaco probe heating than internal metal stress. The temperature increase due to internal metal stress was greater with axial mode than with torsional mode. Dr. Zacharias received research funding from Alcon Laboratories, Inc., to conduct this study. He has no financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Corneal graft reversal: Histopathologic report of two cases.

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Qahtani, Abdullah A; Alkatan, Hind M

2014-10-01

Graft reversal is a rare cause for failed PKP. In this case report we are presenting 2 graft failure cases in which the corneal grafts were reversed unintentionally. The onset of signs of graft failure, however was variable. We have included their clinical course and the histopathologic findings of the removed corneal grafts. A total of 6 cases including ours have been reported so far. The aim of this report is to attract the attention of corneal surgeons to an additional rare cause for failed penetrating keratoplasty (PKP) which is donor graft reversal.

Fluorouracil as a treatment for corneal papilloma in a Malayan tapir.

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Karpinski, Lorraine G; Miller, Christine L

2002-09-01

A 26-year-old, wild caught, male Malayan tapir at the Miami Metrozoo with bilateral corneal papillomas was serially immobilized and given subconjunctival injections of fluorouracil. Over the course of 17 weeks five bilateral injections of 25 mg fluorouracil were given. This treatment caused regression of the corneal lesions as evidenced by decreased lesion diameter, decreased corneal vascularity, increased corneal clarity, and improved visual function. No adverse drug effects were observed.

Evaluation of corneal higher order aberrations in normal topographic patterns

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Ali Mirzajani

2016-06-01

Conclusions: Based on results in this study, there were a good correlation between corneal topographic pattern and corneal HOAs in normal eyes. These results indicate that the corneal HOAs values are largely determined by the topographic patterns. A larger sample size would perhaps have been beneficial to yield in more accurate outcomes.

Algorithm for Correcting the Keratometric Error in the Estimation of the Corneal Power in Keratoconus Eyes after Accelerated Corneal Collagen Crosslinking

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David P. Piñero

2017-01-01

Full Text Available Purpose. To analyze the errors associated to corneal power calculation using the keratometric approach in keratoconus eyes after accelerated corneal collagen crosslinking (CXL surgery and to obtain a model for the estimation of an adjusted corneal refractive index nkadj minimizing such errors. Methods. Potential differences (ΔPc among keratometric (Pk and Gaussian corneal power (PcGauss were simulated. Three algorithms based on the use of nkadj for the estimation of an adjusted keratometric corneal power (Pkadj were developed. The agreement between Pk1.3375 (keratometric power using the keratometric index of 1.3375, PcGauss, and Pkadj was evaluated. The validity of the algorithm developed was investigated in 21 keratoconus eyes undergoing accelerated CXL. Results. Pk1.3375 overestimated corneal power between 0.3 and 3.2 D in theoretical simulations and between 0.8 and 2.9 D in the clinical study (ΔPc. Three linear equations were defined for nkadj to be used for different ranges of r1c. In the clinical study, differences between Pkadj and PcGauss did not exceed ±0.8 D nk=1.3375. No statistically significant differences were found between Pkadj and PcGauss (p>0.05 and Pk1.3375 and Pkadj (p<0.001. Conclusions. The use of the keratometric approach in keratoconus eyes after accelerated CXL can lead to significant clinical errors. These errors can be minimized with an adjusted keratometric approach.

Ultraviolet induced lysosome activity in corneal epithelium

International Nuclear Information System (INIS)

Cullen, A.P.

1980-01-01

A 5.000 W Xe-Hg high pressure lamp and a double monochromator were used to produce a 3.3 nm half-bandpass ultraviolet radiation at 295 nm. Pigmented rabbit eyes were irradiated with radiant exposures from 140 Jm -2 to 10.000 Jm -2 and evaluated by slit-lamp biomicroscopy, light and electron microscopy. Corneal threshold (Hsub(c) was 200 Jm -2 and lens threshold (Hsub(L)) was 7.500 Jm -2 . The most repeatable and reliable corneal response to these levels of UV was the development of corneal epithelial granules. Histological changes included a loss of superficial epithelial cells and selective UV induced autolysis of the wing cells. It is suggested that the biomicroscopically observed granules are the clinical manifestation of the secondary lysosomes revealed by light and electron microscopy. It is proposed that UV breaks down the primary lysosome membranes to release hydrolytic enzymes which in turn form the secondary lysosomes during autolysis. Extreme levels of radiant exposure at 295 nm result in indiscriminate destruction of all layers of the corneal epithelium, but the posterior cornea was spared. (orig.) [de

Alteraciones corneales en pacientes diabéticos

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Iraisi Hormigó Puertas

Full Text Available La diabetes mellitus, afección frecuente a nivel mundial, tiene gran impacto en la sociedad no solo por su alta prevalencia, sino por sus complicaciones crónicas y su alta mortalidad. Afecta a unos 180 millones de personas en el mundo. La prevalencia de la diabetes (tipos I y II se estima en el 13 % en pacientes mayores de 60 años. La estructura corneal sufre modificaciones en los pacientes diabéticos; la hiperglucemia afecta la hidratación de la córnea, y con esto varía el espesor corneal y aparecen cambios queratométricos visibles mediante topografía corneal. Las córneas de los pacientes con diabetes presentan alteraciones epiteliales, estromales y endoteliales. Además, existe una disminución de la permeabilidad endotelial durante la fase de hipoxia, que relacionan estos efectos de la diabetes en las células endoteliales. El objetivo de nuestro estudio es abordar las diferentes alteraciones corneales en los pacientes diabéticos.

Effect of Viscous Agents on Corneal Density in Dry Eye Disease.

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Wegener, Alfred R; Meyer, Linda M; Schönfeld, Carl-Ludwig

2015-10-01

To investigate the effect of the viscous agents, hydroxypropyl methylcellulose (HPMC), carbomer, povidone, and a combination of HPMC and povidone on corneal density in patients with dry eye disease. In total, 98 eyes of 49 patients suffering from dry eye and 65 eyes of 33 healthy age-matched individuals were included in this prospective, randomized study. Corneal morphology was documented with Scheimpflug photography and corneal density was analyzed in 5 anatomical layers (epithelium, bowman membrane, stroma, descemet's membrane, and endothelium). Corneal density was evaluated for the active ingredients HPMC, carbomer, povidone, and a combination of HPMC and povidone as the viscous agents contained in the artificial tear formulations used by the dry eye patients. Data were compared to the age-matched healthy control group without medication. Corneal density in dry eye patients was reduced in all 5 anatomical layers compared to controls. Corneal density was highest and very close to control in patients treated with HPMC containing ocular lubricants. Patients treated with lubricants, including carbomer as the viscous agent displayed a significant reduction of corneal density in layers 1 and 2 compared to control. HPMC containing ocular lubricants can help to maintain physiological corneal density and may be beneficial in the treatment of dry eye disease.

Healed corneal ulcer with keloid formation

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Alkatan, Hind M.; Al-Arfaj, Khalid M.; Hantera, Mohammed; Al-Kharashi, Soliman

2012-01-01

We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman’s layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a co...

Corneal thickness changes during corneal collagen cross-linking with UV-A irradiation and hypo-osmolar riboflavin in thin corneas

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Belquiz Amaral Nassaralla

2013-06-01

Full Text Available PURPOSE: To evaluate the thinnest corneal thickness changes during and after corneal collagen cross-linking treatment with ultraviolet-A irradiation, using hypo-osmolar riboflavin solution in thin corneas. METHODS: Eighteen eyes of 18 patients were included in this study. After epithelium removal, iso-osmolar 0.1% riboflavin solution was instilled to the cornea every 3 minutes for 30 minutes. Hypo-osmolar 0.1% riboflavin solution was then applied every 20 seconds for 5 minutes or until the thinnest corneal thickness reached 400 µm. Ultraviolet-A irradiation was performed for 30 minutes. During irradiation, iso-osmolar 0.1% riboflavin drops were applied every 5 minutes. Ultrasound pachymetry was performed at approximately the thinnest point of the cornea preoperatively, after epithelial removal, after iso-osmolar riboflavin instillation, after hypo-osmolar riboflavin instillation, after ultraviolet-A irradiation, and at 1, 6 and 12 months after treatment. RESULTS: Mean preoperative thinnest corneal thickness was 380 ± 11 µm. After epithelial removal it decreased to 341 ± 11 µm, and after 30 minutes of iso-osmolar 0.1% riboflavin drops, to 330 ± 7.6 µm. After hypo-osmolar 0.1% riboflavin drops, mean thinnest corneal thickness increased to 418 ± 11 µm. After UVA irradiation, it was 384 ± 10 µm. At 1, 6 and 12 months after treatment, it was 372 ± 10 µm, 381 ± 12.7, and 379 ± 15 µm, respectively. No intraoperative, early postoperative, or late postoperative complications were noted. CONCLUSIONS: Hypo-osmolar 0.1% riboflavin solution seems to be effective for swelling thin corneas. The swelling effect is transient and short acting. Corneal thickness should be monitored throughout the procedure. Larger sample sizes and longer follow-up are required in order to make meaningful conclusions regarding safety.

CD147 required for corneal endothelial lactate transport.

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Li, Shimin; Nguyen, Tracy T; Bonanno, Joseph A

2014-06-26

CD147/basigin is a chaperone for lactate:H(+) cotransporters (monocarboxylate transporters) MCT1 and MCT4. We tested the hypothesis that MCT1 and -4 in corneal endothelium contribute to lactate efflux from stroma to anterior chamber and that silencing CD147 expression would cause corneal edema. CD147 was silenced via small interfering ribonucleic acid (siRNA) transfection of rabbit corneas ex vivo and anterior chamber lenti-small hairpin RNA (shRNA) pseudovirus in vivo. CD147 and MCT expression was examined by Western blot, RT-PCR, and immunofluorescence. Functional effects were examined by measuring lactate-induced cell acidification, corneal lactate efflux, [lactate], central cornea thickness (CCT), and Azopt (a carbonic anhydrase inhibitor) sensitivity. In ex vivo corneas, 100 nM CD147 siRNA reduced CD147, MCT1, and MCT4 expression by 85%, 79%, and 73%, respectively, while MCT2 expression was unaffected. CD147 siRNA decreased lactate efflux from 3.9 ± 0.81 to 1.5 ± 0.37 nmol/min, increased corneal [lactate] from 19.28 ± 7.15 to 56.73 ± 8.97 nmol/mg, acidified endothelial cells (pHi = 6.83 ± 0.07 vs. 7.19 ± 0.09 in control), and slowed basolateral lactate-induced acidification from 0.0034 ± 0.0005 to 0.0012 ± 0.0005 pH/s, whereas apical acidification was unchanged. In vivo, CD147 shRNA increased CCT by 28.1 ± 0.9 μm at 28 days; Azopt increased CCT to 24.4 ± 3.12 vs. 12.0 ± 0.48 μm in control, and corneal [lactate] was 47.63 ± 6.29 nmol/mg in shCD147 corneas and 17.82 ± 4.93 nmol/mg in paired controls. CD147 is required for the expression of MCT1 and MCT4 in the corneal endothelium. Silencing CD147 slows lactate efflux, resulting in stromal lactate accumulation and corneal edema, consistent with lactate efflux as a significant component of the corneal endothelial pump. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Low temperature corneal laser welding investigated by atomic force microscopy

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Matteini, Paolo; Sbrana, Francesca; Tiribilli, Bruno; Pini, Roberto

2009-02-01

The structural modifications in the stromal matrix induced by low-temperature corneal laser welding were investigated by atomic force microscopy (AFM). This procedure consists of staining the wound with Indocyanine Green (ICG), followed by irradiation with a near-infrared laser operated at low-power densities. This induces a local heating in the 55-65 °C range. In welded tissue, extracellular components undergo heat-induced structural modifications, resulting in a joining effect between the cut edges. However, the exact mechanism generating the welding, to date, is not completely understood. Full-thickness cuts, 3.5 mm in length, were made in fresh porcine cornea samples, and these were then subjected to laser welding operated at 16.7 W/cm2 power density. AFM imaging was performed on resin-embedded semi-thin slices once they had been cleared by chemical etching, in order to expose the stromal bulk of the tissue within the section. We then carried out a morphological analysis of characteristic fibrillar features in the laser-treated and control samples. AFM images of control stromal regions highlighted well-organized collagen fibrils (36.2 +/- 8.7 nm in size) running parallel to each other as in a typical lamellar domain. The fibrils exhibited a beaded pattern with a 22-39 nm axial periodicity. Laser-treated corneal regions were characterized by a significant disorganization of the intralamellar architecture. At the weld site, groups of interwoven fibrils joined the cut edges, showing structural properties that were fully comparable with those of control regions. This suggested that fibrillar collagen is not denatured by low-temperature laser welding, confirming previous transmission electron microscopy (TEM) observations, and thus it is probably not involved in the closure mechanism of corneal cuts. The loss of fibrillar organization may be related to some structural modifications in some interfibrillar substance as proteoglycans or collagen VI. Furthermore, AFM

Case Report: Corneal Pyogenic Granuloma: Rare Complication of ...

African Journals Online (AJOL)

Slit lamp examination showed vascularized central corneal mass with surrounding stromal infiltrates. The mass was excised, and histopathological examination confirmed pyogenic granuloma of the cornea. Conclusion: Corneal pyogenic granuloma could be a rare complication of infectious keratitis. Therefore, it should be ...

A STUDY ON PREVALENCE AND CAUSES OF CORNEAL BLINDNESS IN PAEDIATRIC AGE GROUP

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E. Ramadevi

2017-12-01

Full Text Available BACKGROUND Corneal disease is responsible for less than 2% of blindness in children in industrialised countries. In poor countries of the world, corneal scarring occurs due to vitamin A deficiency, measles and ophthalmia neonatorum. Thus, corneal disease is an important cause of blindness among children living in developing nations, which already carry a major burden of blindness. The aim of the study is to study the1. Prevalence of corneal blindness in the paediatric age group. 2. Causes of corneal blindness in the paediatric age group. 3. Morbidity of corneal blindness in the paediatric age group. MATERIALS AND METHODS It was cross-sectional observational study. Study Period- December 2014 to August 2016. Study Done- Government General Hospital, Kakinada. Sample Size- 50 patients. Inclusion Criteria- Children of age group 6 to 12 years with corneal blindness who have attended the outpatient department during the study period. Exclusion Criteria- Children with childhood blindness other than corneal pathology. Study Tools- Predesigned, semi-structured questionnaire regarding age, sex and age of onset of visual loss, laterality, history of ocular injury, vitamin A immunisation, family history of consanguinity and place of residence and socioeconomic status was taken. Visual acuity was measured using an E optotype and Landolt broken C chart with best corrected vision. Visual loss was classified according to the WHO categories of visual impairment. Ophthalmic examination was done by slit lamp and B scan. RESULTS Ocular trauma and corneal ulcers are most common cause of corneal blindness. 84% of corneal blindness cases were preventable and curable. CONCLUSION Trauma was the commonest cause of corneal blindness followed by infectious keratitis. 84% of corneal blindness was preventable and curable. Most causes of corneal blindness were avoidable.

Alternatives to eye bank native tissue for corneal stromal replacement.

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Brunette, Isabelle; Roberts, Cynthia J; Vidal, François; Harissi-Dagher, Mona; Lachaine, Jean; Sheardown, Heather; Durr, Georges M; Proulx, Stéphanie; Griffith, May

2017-07-01

Corneal blindness is a major cause of blindness in the world and corneal transplantation is the only widely accepted treatment to restore sight in these eyes. However, it is becoming increasingly difficult for eye banks to meet the increasing demand for transplantable tissue, which is in part due to population aging. Donor tissue shortage is therefore a growing concern globally and there is a need for alternatives to human donor corneas. Biosynthetic corneal substitutes offer several significant advantages over native corneas: Large-scale production offers a powerful potential solution to the severe shortage of human donor corneas worldwide; Good manufacturing practices ensure sterility and quality control; Acellular corneal substitutes circumvent immune rejection induced by allogeneic cells; Optical and biomechanical properties of the implants can be adapted to the clinical need; and finally these corneal substitutes could benefit from new advances in biomaterials science, such as surface coating, functionalization and nanoparticles. This review highlights critical contributions from laboratories working on corneal stromal substitutes. It focuses on synthetic inert prostheses (keratoprostheses), acellular scaffolds with and without enhancement of endogenous regeneration, and cell-based replacements. Accent is put on the physical properties and biocompatibility of these biomaterials, on the functional and clinical outcome once transplanted in vivo in animal or human eyes, as well as on the main challenges of corneal stromal replacement. Regulatory and economic aspects are also discussed. All of these perspectives combined highlight the founding principles of the clinical application of corneal stromal replacement, a concept that has now become reality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Excimer laser corneal surgery and free oxygen radicals.

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Bilgihan, K; Bilgihan, A; Akata, F; Hasanreisoğlu, B; Türközkan, N

1996-01-01

Corneal photoablation with 193 nm argon fluoride excimer laser is a new technique for the treatment of refractive errors and for removing corneal opacities and irregularities. Ultraviolet radiation and thermal injury induce free radical formation in the tissues. The aim of this study was to confirm the production of free radicals by excimer laser photoablation in rabbits. The thermal changes of the posterior corneal surface were recorded during excimer laser photoablation. The lipid peroxide (LPO) levels and superoxide dismutase (SOD) activities of aqueous humour were measured after excimer laser keratectomy. The aqueous LPO levels were not changed after excimer laser ablation, but both the thermal increase in the cornea during the photoablation and the decreased aqueous SOD activities suggest that free radicals are formed in the cornea during excimer laser keratectomy, and that they may be responsible for some of the complications of excimer laser corneal surgery.

Distrofia corneal granular

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Alexeide de la C Castillo Pérez

Full Text Available Las distrofias corneales constituyen un conjunto de enfermedades que presentan, en su mayoría, una baja incidencia y se caracterizan por acúmulo de material hialino o amiloide que disminuyen la transparencia corneal. La distrofia granular es una enfermedad autosómica dominante que presenta opacidades grises en el estroma superficial central de la córnea y se hacen visibles en la primera y segunda décadas de la vida, lo que provoca disminución de la visión más significativa cerca de los 40 años de edad. Presentamos dos casos clínicos de distrofia granular en pacientes hermanos de diferentes sexos, quienes acudieron a la consulta y refirieron visión nublada. El estudio de la historia familiar nos ayuda en el correcto diagnóstico y la biomicroscopia constituye el elemento más importante.

The theory and art of corneal cross-linking.

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McQuaid, Rebecca; Cummings, Arthur B; Mrochen, Michael

2013-08-01

Before the discovery of corneal cross-linking (CXL), patients with keratoconus would have had to undergo corneal transplantation, or wear rigid gas permeable lenses (RGPs) that would temporarily flatten the cone, thereby improving the vision. The RGP contact lens (CL) would not however alter the corneal stability and if the keratoconus was progressive, the continued steepening of the cone would occur under the RGP CL. To date, the Siena Eye has been the largest study to investigate long term effects of standard CXL. Three hundred and sixty-three eyes were treated and monitored over 4 years, producing reliable long-term results proving long-term stability of the cornea by halting the progression of keratoconus, and proving the safety of the procedure. Traditionally, CXL requires epithelial removal prior to corneal soakage of a dextran-based 0.1% riboflavin solution, followed by exposure of ultraviolet-A (UV-A) light for 30 min with an intensity of 3 mW/cm2. A series of in vitro investigations on human and porcine corneas examined the best treatment parameters for standard CXL, such as riboflavin concentration, intensity, wavelength of UV-A light, and duration of treatment. Photochemically, CXL is achieved by the generation of chemical bonds within the corneal stroma through localized photopolymerization, strengthening the cornea whilst minimizing exposure to the surrounding structures of the eye. In vitro studies have shown that CXL has an effect on the biomechanical properties of the cornea, with an increased corneal rigidity of approximately 70%. This is a result of the creation of new chemical bonds within the stroma.

Comparison of parametric methods for modeling corneal surfaces

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Bouazizi, Hala; Brunette, Isabelle; Meunier, Jean

2017-02-01

Corneal topography is a medical imaging technique to get the 3D shape of the cornea as a set of 3D points of its anterior and posterior surfaces. From these data, topographic maps can be derived to assist the ophthalmologist in the diagnosis of disorders. In this paper, we compare three different mathematical parametric representations of the corneal surfaces leastsquares fitted to the data provided by corneal topography. The parameters obtained from these models reduce the dimensionality of the data from several thousand 3D points to only a few parameters and could eventually be useful for diagnosis, biometry, implant design etc. The first representation is based on Zernike polynomials that are commonly used in optics. A variant of these polynomials, named Bhatia-Wolf will also be investigated. These two sets of polynomials are defined over a circular domain which is convenient to model the elevation (height) of the corneal surface. The third representation uses Spherical Harmonics that are particularly well suited for nearly-spherical object modeling, which is the case for cornea. We compared the three methods using the following three criteria: the root-mean-square error (RMSE), the number of parameters and the visual accuracy of the reconstructed topographic maps. A large dataset of more than 2000 corneal topographies was used. Our results showed that Spherical Harmonics were superior with a RMSE mean lower than 2.5 microns with 36 coefficients (order 5) for normal corneas and lower than 5 microns for two diseases affecting the corneal shapes: keratoconus and Fuchs' dystrophy.

Unilateral corneal leukoplakia without limbal involvement

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Hirano K

2015-05-01

Full Text Available Koji Hirano,1 Mihoko Koide,2 Yoshikazu Mizoguchi,3 Yasuhiro Osakabe,4 Kaoru-Araki Sasaki5 1Department of Ophthalmology, Ban Buntane Hotokukai Hospital, School of Medicine, Fujita Health University, Nagoya, Japan; 2Koide Internal Medicine and Eye Clinic, Nagoya, Japan; 3Department of Pathology, Ban Buntane Hotokukai Hospital, School of Medicine, Fujita Health University, Nagoya, Japan; 4Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan; 5Department of Ophthalmology, Japan Health Care Organization, Hoshigaoka Medical Center, Hirakata, Japan Purpose: Leukoplakia is the term given to a white patch or plaque that is found mainly on the oral mucus membrane. It can occasionally be seen on the corneal surface. We report our clinical and histopathological findings in a case of unilateral corneal leukoplakia. Methods: A 26-year-old woman was referred to our hospital because of a white patch on her right cornea that continued to expand. She first noticed the white patch when she was 20 years old, and the white patch had expanded to cover the pupillary area affecting her vision. After plastic surgery on both eyelids for bilateral entropion to alleviate the pain caused by the eyelashes rubbing the cornea, the white corneal patch decreased in size. Because of this reduction, we performed surgery to remove the patch with microforceps under topical anesthesia. The plaque was removed easily and completely, and submitted for histopathological examination. Results: Histopathological examination showed that the specimen had characteristics of epidermis with a basal cell layer, spinous cell layer, granular cell layer, and horny layer with hyperkeratosis. She was diagnosed with leukoplakia of the corneal surface. The basic structure of the squamous cell layer was preserved, and there were no signs of metaplasia. Six months after the removal of the leukoplakia, no recurrence was seen and her corrected decimal visual acuity recovered to 1

Influence of eye biometrics and corneal micro-structure on noncontact tonometry.

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Danilo A Jesus

Full Text Available Tonometry is widely used as the main screening tool supporting glaucoma diagnosis. Still, its accuracy could be improved if full knowledge about the variation of the corneal biomechanical properties was available. In this study, Optical Coherence Tomography (OCT speckle statistics are used to infer the organisation of the corneal micro-structure and hence, to analyse its influence on intraocular pressure (IOP measurements.Fifty-six subjects were recruited for this prospective study. Macro and micro-structural corneal parameters as well as subject age were considered. Macro-structural analysis included the parameters that are associated with the ocular anatomy, such as central corneal thickness (CCT, corneal radius, axial length, anterior chamber depth and white-to-white corneal diameter. Micro-structural parameters which included OCT speckle statistics were related to the internal organisation of the corneal tissue and its physiological changes during lifetime. The corneal speckle obtained from OCT was modelled with the Generalised Gamma (GG distribution that is characterised with a scale parameter and two shape parameters.In macro-structure analysis, only CCT showed a statistically significant correlation with IOP (R2 = 0.25, p<0.001. The scale parameter and the ratio of the shape parameters of GG distribution showed statistically significant correlation with IOP (R2 = 0.19, p<0.001 and R2 = 0.17, p<0.001, respectively. For the studied group, a weak, although significant correlation was found between age and IOP (R2 = 0.053, p = 0.04. Forward stepwise regression showed that CCT and the scale parameter of the Generalised Gamma distribution can be combined in a regression model (R2 = 0.39, p<0.001 to study the role of the corneal structure on IOP.We show, for the first time, that corneal micro-structure influences the IOP measurements obtained from noncontact tonometry. OCT speckle statistics can be employed to learn about the corneal micro

Influence of eye biometrics and corneal micro-structure on noncontact tonometry.

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Jesus, Danilo A; Majewska, Małgorzata; Krzyżanowska-Berkowska, Patrycja; Iskander, D Robert

2017-01-01

Tonometry is widely used as the main screening tool supporting glaucoma diagnosis. Still, its accuracy could be improved if full knowledge about the variation of the corneal biomechanical properties was available. In this study, Optical Coherence Tomography (OCT) speckle statistics are used to infer the organisation of the corneal micro-structure and hence, to analyse its influence on intraocular pressure (IOP) measurements. Fifty-six subjects were recruited for this prospective study. Macro and micro-structural corneal parameters as well as subject age were considered. Macro-structural analysis included the parameters that are associated with the ocular anatomy, such as central corneal thickness (CCT), corneal radius, axial length, anterior chamber depth and white-to-white corneal diameter. Micro-structural parameters which included OCT speckle statistics were related to the internal organisation of the corneal tissue and its physiological changes during lifetime. The corneal speckle obtained from OCT was modelled with the Generalised Gamma (GG) distribution that is characterised with a scale parameter and two shape parameters. In macro-structure analysis, only CCT showed a statistically significant correlation with IOP (R2 = 0.25, p<0.001). The scale parameter and the ratio of the shape parameters of GG distribution showed statistically significant correlation with IOP (R2 = 0.19, p<0.001 and R2 = 0.17, p<0.001, respectively). For the studied group, a weak, although significant correlation was found between age and IOP (R2 = 0.053, p = 0.04). Forward stepwise regression showed that CCT and the scale parameter of the Generalised Gamma distribution can be combined in a regression model (R2 = 0.39, p<0.001) to study the role of the corneal structure on IOP. We show, for the first time, that corneal micro-structure influences the IOP measurements obtained from noncontact tonometry. OCT speckle statistics can be employed to learn about the corneal micro-structure and

Successful transplantation of in vitro expanded human corneal endothelial precursors to corneal endothelial surface using a nanocomposite sheet

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Parikumar P

2011-01-01

Full Text Available Background: Though the transplantation of in vitro expanded human corneal endothelial precursors in animal models of endothelial damage by injecting into the anterior chamber has been reported, the practical difficulties of accomplishing such procedure in human patients have been a hurdle to clinical translation. Here we report the successful transplantation of in vitro expanded human corneal precursor cells to an animal eye using a transparent Nano-composite sheet and their engraftment.Materials and Methods: Human Corneal endothelial cells (HCEC were isolated from human cadaver eyes with informed consent and expanded in the lab using a sphere forming assay in a novel Thermoreversible Gelation Polymer (TGP for 26 days. HCEC obtained by sphere forming assay were seeded in a novel Nano-composite sheet, which was made of PNIPA-NC gels by in-situ, free-radical polymerization of NIPA monomer in the presence of exfoliated clay (synthetic hectorite “Laponite XLG” uniformly dispersed in aqueous media. After a further seven days in vitro culture of HCEC in the Nano-composite sheet, cells were harvested and transplanted on cadaver-bovine eyes (n=3. The cells were injected between the corneal endothelial layer and the Nano-composite sheet that had been placed prior to the injection in close proximity to the endothelial layer. After three hours, the transplanted Nano-composite sheets were removed from the bovine eyes and subjected to microscopic examination. The corneas were subjected to Histo-pathological studies along with controls. Results: HCEC formed sphere like colonies in TGP which expressed relevant markers as confirmed by RT-PCR. Microscopic studies of the Nanosheets and histopathological studies of the cornea of the Bull’s eye revealed that the HCEC got engrafted to the corneal endothelial layer of the bovine eyes with no remnant cells in the Nanosheet. Conclusion: Transplantation of in vitro expanded donor human corneal endothelial cells

Preliminary results of a prospective study of inter- and intra-user variability of the Royal Veterinary College corneal clarity score (RVC-CCS) for use in veterinary practice.

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Sanchez, Rick F; Dawson, Charlotte; Matas Riera, Màrian; Escanilla, Natàlia

2016-07-01

To introduce a new corneal clarity score for use in small animals and describe its inter- and intra-user variability. Twelve dogs and two cats with corneal abnormalities and five dogs with healthy corneas. Four examiners scored every patient twice and never consecutively, focusing on the central cornea. The peripheral cornea was scored separately. The following scoring system was used to describe corneal clarity: G0: no fundus reflection is visible on retroillumination (RI) using a head-mounted indirect ophthalmoscope. G1: a fundus reflection is visible with RI. G2: a 0.1-mm diameter light beam is visible on the anterior surface of the iris and/or lens. G3: gross fundic features are visible when viewed with indirect ophthalmoscopy (IO) using a head-mounted indirect ophthalmoscope and a hand-held 30D lens, although fine details are not clear. G4: fine details of the fundic features are clearly visible with IO. The minimum grades given were analyzed for inter- and intra-user variability with kappa analysis. Intra- and interuser variability of the central corneal clarity ranged from 0.78 to 0.96, showing substantial to almost perfect reproducibility, and from 0.66 to 0.91, showing substantial to almost perfect reliability, respectively. Intra- and interuser variability of the peripheral cornea ranged from 0.83 to 0.95, showing almost perfect agreement, and from 0.53 to 0.91, showing moderate to almost perfect agreement. The RVC-CCS is well suited to assess and monitor central corneal clarity in small animals and to compare outcomes between studies and different surgeons. © 2015 American College of Veterinary Ophthalmologists.

Corneal elastosis within lattice dystrophy lesions.

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Pe'er, J; Fine, B S; Dixon, A; Rothberg, D S

1988-01-01

Corneal buttons of two patients with lattice corneal dystrophy were studied by light and electron microscopy. They showed elastotic degeneration within the amyloid deposits. The amyloid deposits displayed characteristic staining; the elastotic material (elastin) within the deposits stained positive with Verhoeff-van Gieson and Movat pentachrome stains and showed autofluorescence. The characteristic ultrastructural findings of amyloid and elastotic material were also demonstrated. The possibility of the associations of these two materials in the cornea is discussed. Images PMID:3258531

Do topical antibiotics help corneal epithelial trauma?

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King, J. W.; Brison, R. J.

1993-01-01

Topical antibiotics are routinely used in emergency rooms to treat corneal trauma, although no published evidence supports this treatment. In a noncomparative clinical trial, 351 patients with corneal epithelial injuries were treated without antibiotics. The infection rate was 0.7%, suggesting that such injuries can be safely and effectively managed without antibiotics. A comparative clinical trial is neither warranted nor feasible.

Applications of biomaterials in corneal wound healing

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I-Lun Tsai

2015-04-01

Full Text Available Disease affecting the cornea is a common cause of blindness worldwide. To date, the amniotic membrane (AM is the most widely used clinical method for cornea regeneration. However, donor-dependent differences in the AM may result in variable clinical outcomes. To overcome this issue, biomaterials are currently under investigation for corneal regeneration in vitro and in vivo. In this article, we highlight the recent advances in hydrogels, bioengineered prosthetic devices, contact lenses, and drug delivery systems for corneal regeneration. In clinical studies, the therapeutic effects of biomaterials, including fibrin and collagen-based hydrogels and silicone contact lenses, have been demonstrated in damaged cornea. The combination of cells and biomaterials may provide potential treatment in corneal wound healing in the future.

Real-time assessment of corneal endothelial cell damage following graft preparation and donor insertion for DMEK.

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Maninder Bhogal

Full Text Available To establish a method for assessing graft viability, in-vivo, following corneal transplantation.Optimization of calcein AM fluorescence and toxicity assessment was performed in cultured human corneal endothelial cells and ex-vivo corneal tissue. Descemet membrane endothelial keratoplasty grafts were incubated with calcein AM and imaged pre and post preparation, and in-situ after insertion and unfolding in a pig eye model. Global, macroscopic images of the entire graft and individual cell resolution could be attained by altering the magnification of a clinical confocal scanning laser microscope. Patterns of cell loss observed in situ were compared to those seen using standard ex-vivo techniques.Calcein AM showed a positive dose-fluorescence relationship. A dose of 2.67μmol was sufficient to allow clear discrimination between viable and non-viable areas (sensitivity of 96.6% with a specificity of 96.1% and was not toxic to cultured endothelial cells or ex-vivo corneal tissue. Patterns of cell loss seen in-situ closely matched those seen on ex-vivo assessment with fluorescence viability imaging, trypan blue/alizarin red staining or scanning electron microscopy. Iatrogenic graft damage from preparation and insertion varied between 7-35% and incarceration of the graft tissue within surgical wounds was identified as a significant cause of endothelial damage.In-situ graft viability assessment using clinical imaging devices provides comparable information to ex-vivo methods. This method shows high sensitivity and specificity, is non-toxic and can be used to evaluate immediate cell viability in new grafting techniques in-vivo.

Inhibition of Corneal Neovascularization by Topical and Subconjunctival Tigecycline

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Sertan Goktas

2014-01-01

Full Text Available Objective. To investigate the effects of topical and subconjunctival tigecycline on the prevention of corneal neovascularization. Materials and Methods. Following chemical burn, thirty-two rats were treated daily with topical instillation of 1 mg/mL tigecycline (group 1 or subconjunctival instillation of 1 mg/mL tigecycline (group 3 for 7 days. Control rats received topical (group 2 or subconjunctival (group 4 0.9% saline. Digital photographs of the cornea were taken on the eighth day after treatment and analyzed to determine the percentage area of the cornea covered by neovascularization. Corneal sections were analyzed histopathologically. Results. The median percentages of corneal neovascularization in groups 1 and 3 were 48% (95% confidence interval (CI, 44.2–55.8% and 33.5% (95% CI, 26.6–39.2%, respectively. The median percentages of corneal neovascularization of groups 1 and 3 were significantly lower than that of the control group (P=0.03 and P<0.001, resp.. Histologic examination of samples from groups 1 and 3 showed lower vascularity than that of control groups. Conclusion. Topical and subconjunctival administration of tigecycline seems to be showing promising therapeutic effects on the prevention of corneal neovascularization. Furthermore, subconjunctival administration of tigecycline is more potent than topical administration in the inhibition of corneal neovascularization.

Thick keratoconic cornea associated with posterior polymorphous corneal dystrophy.

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Zaarour, K; Slim, E; Antoun, J; Waked, N

2017-03-01

We herein report a case of bilateral unusually thick non-edematous keratoconic corneas with associated endothelial features of posterior polymorphous corneal dystrophy (PPCD). We report the case of a 27-year-old myopic woman who presented for refractive surgery. Slit lamp exam showed bilateral corneal protrusion with diffuse deep stromal and endothelial vesicular opacities and small paracentral bands. Topography showed generalized advanced corneal steepening in both eyes with increased anterior and posterior central corneal elevations in comparison to the best fit sphere. Ultrasound pachymetry showed central corneal thickness of 605μm (RE) and 612μm (LE). On specular biomicroscopy, cell density of 2503 cells/mm 2 RE and 1526 cells/mm 2 LE with significant cellular pleomorphism and polymegathism were noted. Clinical and paraclinical findings together suggest the presence of simultaneous keratoconus and PPCD. The literature has suggested an association between PPCD and steep cornea. Moreover, many reports have also described cases of associated PPCD and keratoconus with characteristic thinning and ectasia, in comparison to the unusual thick corneas noted in our patient, despite the absence of edema. Identification of genetics factors is further needed to clarify this association. This case describes a patient whose corneas present features of both keratoconus and PPCD and is unique due to the presence of increased corneal thickness despite the absence of edema. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

An experimental model of mycobacterial infection under corneal flaps

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C.B.D. Adan

2004-07-01

Full Text Available In order to develop a new experimental animal model of infection with Mycobacterium chelonae in keratomileusis, we conducted a double-blind prospective study on 24 adult male New Zealand rabbits. One eye of each rabbit was submitted to automatic lamellar keratotomy with the automatic corneal shaper under general anesthesia. Eyes were immunosuppressed by a single local injection of methyl prednisolone. Twelve animals were inoculated into the keratomileusis interface with 1 µl of 10(6 heat-inactivated bacteria (heat-inactivated inoculum controls and 12 with 1 µl of 10(6 live bacteria. Trimethoprim drops (0.1%, w/v were used as prophylaxis for the surgical procedure every 4 h (50 µl, qid. Animals were examined by 2 observers under a slit lamp on the 1st, 3rd, 5th, 7th, 11th, 16th, and 23rd postoperative days. Slit lamp photographs were taken to document clinical signs. Animals were sacrificed when corneal disease was detected and corneal samples were taken for microbiological analysis. Eleven of 12 experimental rabbits developed corneal disease, and M. chelonae could be isolated from nine rabbits. Eleven of the 12 controls receiving a heat-inactivated inoculum did not develop corneal disease. M. chelonae was not isolated from any of the control rabbits receiving a heat-inactivated inoculum, or from the healthy cornea of control rabbits. Corneal infection by M. chelonae was successfully induced in rabbits submitted to keratomileusis. To our knowledge, this is the first animal model of M. chelonae infection following corneal flaps for refractive surgery to be described in the literature and can be used for the analysis of therapeutic responses.

The Favorable Effect of Mesenchymal Stem Cell Treatment on the Antioxidant Protective Mechanism in the Corneal Epithelium and Renewal of Corneal Optical Properties Changed after Alkali Burns

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Cejka, Cestmir; Holan, Vladimir; Trosan, Peter; Zajicova, Alena; Javorkova, Eliska; Cejkova, Jitka

2016-01-01

The aim of this study was to examine whether mesenchymal stem cells (MSCs) and/or corneal limbal epithelial stem cells (LSCs) influence restoration of an antioxidant protective mechanism in the corneal epithelium and renewal of corneal optical properties changed after alkali burns. The injured rabbit corneas (with 0.25 N NaOH) were untreated or treated with nanofiber scaffolds free of stem cells, with nanofiber scaffolds seeded with bone marrow MSCs (BM-MSCs), with adipose tissue MSCs (Ad-MSCs), or with LSCs. On day 15 following the injury, after BM-MSCs or LSCs nanofiber treatment (less after Ad-MSCs treatment) the expression of antioxidant enzymes was restored in the regenerated corneal epithelium and the expressions of matrix metalloproteinase 9 (MMP9), inducible nitric oxide synthase (iNOS), α-smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1), and vascular endothelial factor (VEGF) were low. The central corneal thickness (taken as an index of corneal hydration) increased after the injury and returned to levels before the injury. In injured untreated corneas the epithelium was absent and numerous cells revealed the expressions of iNOS, MMP9, α-SMA, TGF-β1, and VEGF. In conclusion, stem cell treatment accelerated regeneration of the corneal epithelium, restored the antioxidant protective mechanism, and renewed corneal optical properties. PMID:27057279

The Favorable Effect of Mesenchymal Stem Cell Treatment on the Antioxidant Protective Mechanism in the Corneal Epithelium and Renewal of Corneal Optical Properties Changed after Alkali Burns.

Science.gov (United States)

Cejka, Cestmir; Holan, Vladimir; Trosan, Peter; Zajicova, Alena; Javorkova, Eliska; Cejkova, Jitka

2016-01-01

The aim of this study was to examine whether mesenchymal stem cells (MSCs) and/or corneal limbal epithelial stem cells (LSCs) influence restoration of an antioxidant protective mechanism in the corneal epithelium and renewal of corneal optical properties changed after alkali burns. The injured rabbit corneas (with 0.25 N NaOH) were untreated or treated with nanofiber scaffolds free of stem cells, with nanofiber scaffolds seeded with bone marrow MSCs (BM-MSCs), with adipose tissue MSCs (Ad-MSCs), or with LSCs. On day 15 following the injury, after BM-MSCs or LSCs nanofiber treatment (less after Ad-MSCs treatment) the expression of antioxidant enzymes was restored in the regenerated corneal epithelium and the expressions of matrix metalloproteinase 9 (MMP9), inducible nitric oxide synthase (iNOS), α-smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1), and vascular endothelial factor (VEGF) were low. The central corneal thickness (taken as an index of corneal hydration) increased after the injury and returned to levels before the injury. In injured untreated corneas the epithelium was absent and numerous cells revealed the expressions of iNOS, MMP9, α-SMA, TGF-β1, and VEGF. In conclusion, stem cell treatment accelerated regeneration of the corneal epithelium, restored the antioxidant protective mechanism, and renewed corneal optical properties.

The Favorable Effect of Mesenchymal Stem Cell Treatment on the Antioxidant Protective Mechanism in the Corneal Epithelium and Renewal of Corneal Optical Properties Changed after Alkali Burns

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Cestmir Cejka

2016-01-01

Full Text Available The aim of this study was to examine whether mesenchymal stem cells (MSCs and/or corneal limbal epithelial stem cells (LSCs influence restoration of an antioxidant protective mechanism in the corneal epithelium and renewal of corneal optical properties changed after alkali burns. The injured rabbit corneas (with 0.25 N NaOH were untreated or treated with nanofiber scaffolds free of stem cells, with nanofiber scaffolds seeded with bone marrow MSCs (BM-MSCs, with adipose tissue MSCs (Ad-MSCs, or with LSCs. On day 15 following the injury, after BM-MSCs or LSCs nanofiber treatment (less after Ad-MSCs treatment the expression of antioxidant enzymes was restored in the regenerated corneal epithelium and the expressions of matrix metalloproteinase 9 (MMP9, inducible nitric oxide synthase (iNOS, α-smooth muscle actin (α-SMA, transforming growth factor-β1 (TGF-β1, and vascular endothelial factor (VEGF were low. The central corneal thickness (taken as an index of corneal hydration increased after the injury and returned to levels before the injury. In injured untreated corneas the epithelium was absent and numerous cells revealed the expressions of iNOS, MMP9, α-SMA, TGF-β1, and VEGF. In conclusion, stem cell treatment accelerated regeneration of the corneal epithelium, restored the antioxidant protective mechanism, and renewed corneal optical properties.

Dynamic Corneal Surface Mapping with Electronic Speckle Pattern Interferometry

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Iqbal, S.; Gualini, M. M. S.

2013-06-01

In view of the fast advancement in ophthalmic technology and corneal surgery, there is a strong need for the comprehensive mapping and characterization techniques for corneal surface. Optical methods with precision non-contact approaches have been found to be very useful for such bio measurements. Along with the normal mapping approaches, elasticity of corneal surface has an important role in its characterization and needs to be appropriately measured or estimated for broader diagnostics and better prospective surgical results, as it has important role in the post-op corneal surface reconstruction process. Use of normal corneal topographic devices is insufficient for any intricate analysis since these devices operate at relatively moderate resolution. In the given experiment, Pulsed Electronic Speckle Pattern Interferometry has been utilized along with an excitation mechanism to measure the dynamic response of the sample cornea. A Pulsed ESPI device has been chosen for the study because of its micron-level resolution and other advantages in real-time deformation analysis. A bovine cornea has been used as a sample in the subject experiment. The dynamic response has been taken on a chart recorder and it is observed that it does show a marked deformation at a specific excitation frequency, which may be taken as a characteristic elasticity parameter for the surface of that corneal sample. It was seen that outside resonance conditions the bovine cornea was not that much deformed. Through this study, the resonance frequency and the corresponding corneal deformations are mapped and plotted in real time. In these experiments, data was acquired and processed by FRAMES plus computer analysis system. With some analysis of the results, this technique can help us to refine a more detailed corneal surface mathematical model and some preliminary work was done on this. Such modelling enhancements may be useful for finer ablative surgery planning. After further experimentation

Prospective study of Centurion® versus Infiniti® phacoemulsification systems: surgical and visual outcomes.

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Oh, Lawrence J; Nguyen, Chu Luan; Wong, Eugene; Wang, Samuel S Y; Francis, Ian C

2017-01-01

To evaluate surgical outcomes (SOs) and visual outcomes (VOs) in cataract surgery comparing the Centurion ® phacoemulsification system (CPS) with the Infiniti ® phacoemulsification system (IPS). Prospective, consecutive study in a single-site private practice. Totally 412 patients undergoing cataract surgery with either the CPS using the 30-degree balanced ® tip ( n =207) or the IPS using the 30-degree Kelman ® tip ( n =205). Intraoperative and postoperative outcomes were documented prospectively up to one month follow-up. Nuclear sclerosis (NS) grade, cumulated dissipated energy (CDE), preoperative corrected distance visual acuity (CDVA), and CDVA at one month were recorded. CDE was 13.50% less in the whole CPS compared with the whole IPS subcohort. In eyes with NS grade III or greater, CDE was 28.87% less with CPS ( n =70) compared with IPS ( n =44) ( P =0.010). Surgical complications were not statistically different between the two subcohorts ( P =0.083), but in the one case of vitreous loss using the CPS, CDVA of 6/4 was achieved at one month. The mean CDVAs (VOs) at one month for NS grade III and above cataracts were -0.17 logMAR (6/4.5) in the CPS and -0.15 logMAR (6/4.5) in the IPS subcohort respectively ( P =0.033). CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

Ultraviolet induced lysosome activity in corneal epithelium

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Cullen, A.P.

1980-01-01

A 5.000 W Xe-Hg high pressure lamp and a double monochromator were used to produce a 3.3 nm half-bandpass ultraviolet radiation at 295 nm. Pigmented rabbit eyes were irradiated with radiant exposures from 140 Jm/sup -2/ to 10.000 Jm/sup -2/ and evaluated by slit-lamp biomicroscopy, light and electron microscopy. Corneal threshold (Hsub(c) was 200 Jm/sup -2/ and lens threshold (Hsub(L)) was 7.500 Jm/sup -2/. The most repeatable and reliable corneal response to these levels of UV was the development of corneal epithelial granules. Histological changes included a loss of superficial epithelial cells and selective UV induced autolysis of the wing cells. It is suggested that the biomicroscopically observed granules are the clinical manifestation of the secondary lysosomes revealed by light and electron microscopy. It is proposed that UV breaks down the primary lysosome membranes to release hydrolytic enzymes which in turn form the secondary lysosomes during autolysis. Extreme levels of radiant exposure at 295 nm result in indiscriminate destruction of all layers of the corneal epithelium, but the posterior cornea was spared.

A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity.

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Ti, Seng-Ei; Yang, You-Nian; Lang, Stephanie S; Chee, Soon Phaik

2014-01-01

To describe the posterior capsule rupture rates and visual outcomes after phacoemulsification, analyze risk factors for poor vision, and compare results of faculty (F) and residents (R). Retrospective audit study. Visual success of all capsule ruptures (2006-2010) was analyzed and compared to uneventful cases. Rupture rates of faculty and residents were compared (χ², P risk factors were identified using multivariate logistic regression analysis. From 2006 to 2010, there were 887 capsule ruptures in 48 377 phacoemulsification cases (rate 1.8%). Uneventful cases had significantly better visual outcomes than capsule ruptures (98.5% vs 93.9%; P .05). Ruptures most frequently occurred during phacoemulsification (59.6%) and irrigation and aspiration (24.8%) stages. Risk factors for poor outcomes included age >65 years, dropped nuclei, and other complications. The overall capsule rupture rate was 1.8%. Although residents had higher rates, visual success matched faculty's, possibly attributable to case mix and close supervision. Associated risk factors for poor vision included age >65 years, dropped nuclei, and postoperative retinal, corneal, and IOL complications. Copyright © 2014 Elsevier Inc. All rights reserved.

The theory and art of corneal cross-linking

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Rebecca McQuaid

2013-01-01

Full Text Available Before the discovery of corneal cross-linking (CXL, patients with keratoconus would have had to undergo corneal transplantation, or wear rigid gas permeable lenses (RGPs that would temporarily flatten the cone, thereby improving the vision. The RGP contact lens (CL would not however alter the corneal stability and if the keratoconus was progressive, the continued steepening of the cone would occur under the RGP CL. To date, the Siena Eye has been the largest study to investigate long term effects of standard CXL. Three hundred and sixty-three eyes were treated and monitored over 4 years, producing reliable long-term results proving long-term stability of the cornea by halting the progression of keratoconus, and proving the safety of the procedure. Traditionally, CXL requires epithelial removal prior to corneal soakage of a dextran-based 0.1% riboflavin solution, followed by exposure of ultraviolet-A (UV-A light for 30 min with an intensity of 3 mW/cm2. A series of in vitro investigations on human and porcine corneas examined the best treatment parameters for standard CXL, such as riboflavin concentration, intensity, wavelength of UV-A light, and duration of treatment. Photochemically, CXL is achieved by the generation of chemical bonds within the corneal stroma through localized photopolymerization, strengthening the cornea whilst minimizing exposure to the surrounding structures of the eye. In vitro studies have shown that CXL has an effect on the biomechanical properties of the cornea, with an increased corneal rigidity of approximately 70%. This is a result of the creation of new chemical bonds within the stroma.

Effect of corneal cross-linking on contact lens tolerance in keratoconus.

Science.gov (United States)

Ünlü, Metin; Yüksel, Erdem; Bilgihan, Kamil

2017-07-01

The aim was to investigate changes in corneal sensation and rigid gas-permeable (RGP) contact lens tolerance after corneal cross-linking (CXL) on patients with keratoconus. Thirty eyes of 30 patients, who were RGP lens intolerant, were treated with CXL. The main outcome measures were corneal sensation evaluation by Cochet-Bonnet esthesiometry, sub-basal nerve fibre assessment by corneal in vivo confocal microscopy and RGP contact lens tolerance evaluation with the Likert scale and wearing time. All eyes were evaluated preoperatively and post-operatively at one, three and six months after CXL procedure. The mean age was 25.3 ± 6.2 years. Preoperatively, the maximum keratometry (Kmax) in study eyes was 56.89 ± 4.60 D. Six months after CXL, it reduced to 56.03 ± 4.85 D (p = 0.01). Preoperative mean corneal sensation was 0.44 ± 0.05 g/mm 2 , (range: 0.40 to 0.55); it was significantly decreased at the first month and increased to preoperative values after six months. The sub-basal nerve plexus could not be visualised in 90 per cent of the patients by confocal microscopy at one month post-operatively. Gradual restoration of corneal innervation with almost similar preoperative levels at post-operative month six was noted. There were significant differences in Likert scores between preoperative and third and sixth months after CXL. Likert scale scores correlated significantly with corneal sensitivity. It can be concluded that increased RGP contact lens tolerance after CXL may be associated with the potential role of decreased corneal sensitivity and corneal flattening after CXL. © 2016 Optometry Australia.

Transepithelial Riboflavin Absorption in an Ex Vivo Rabbit Corneal Model.

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Gore, Daniel M; O'Brart, David; French, Paul; Dunsby, Chris; Allan, Bruce D

2015-07-01

To measure depth-specific riboflavin concentrations in corneal stroma using two-photon fluorescence microscopy and compare commercially available transepithelial corneal collagen cross-linking (CXL) protocols. Transepithelial CXL riboflavin preparations--MedioCross TE, Ribocross TE, Paracel plus VibeX Xtra, and iontophoresis with Ricrolin+--were applied to the corneal surface of fresh postmortem rabbit eyes in accordance with manufacturers' recommendations for clinical use. Riboflavin 0.1% (VibeX Rapid) was applied after corneal epithelial debridement as a positive control. After riboflavin application, eyes were snap frozen in liquid nitrogen. Corneal cross sections 35-μm thick were cut on a cryostat, mounted on a slide, and imaged by two-photon fluorescence microscopy. Mean (SD) concentrations were calculated from five globes tested for each protocol. Peak riboflavin concentration of 0.09% (± 0.01) was observed within the most superficial stroma (stromal depth 0-10 μm) in positive controls (epithelium-off). At the same depth, peak stromal riboflavin concentrations for MedioCross TE, Ricrolin+, Paracel/Xtra, and Ribocross TE were 0.054% (± 0.01), 0.031% (0.003), 0.021% (± 0.001), and 0.015% (± 0.004), respectively. At a depth of 300 μm (within the demarcation zone commonly seen after corneal cross-linking), the stromal concentration in epithelium-off positive controls was 0.075% (± 0.006), while at the same depth MedioCross TE and Ricrolin+ achieved 0.018% (± 0.006) and 0.016% (0.002), respectively. None of the remaining transepithelial protocols achieved concentrations above 0.005% at this same 300-μm depth. Overall, MedioCross TE was the best-performing transepithelial formulation. Corneal epithelium is a significant barrier to riboflavin absorption into the stroma. Existing commercial transepithelial CXL protocols achieve relatively low riboflavin concentrations in the anterior corneal stroma when compared to gold standard epithelium-off absorption

Selective corneal optical aberration (SCOA) for customized ablation

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Jean, Benedikt J.; Bende, Thomas

2001-06-01

Wavefront analysis still have some technical problems which may be solved within the next years. There are some limitations to use wavefront as a diagnostic tool for customized ablation alone. An ideal combination would be wavefront and topography. Meanwhile Selective Corneal Aberration is a method to visualize the optical quality of a measured corneal surface. It is based on a true measured 3D elevation information of a video topometer. Thus values can be interpreted either using Zernike polynomials or visualized as a so called color coded surface quality map. This map gives a quality factor (corneal aberration) for each measured point of the cornea.

[Corneal manifestations in systemic diseases].

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Zarranz Ventura, J; De Nova, E; Moreno-Montañés, J

2008-01-01

Systemic diseases affecting the cornea have a wide range of manifestations. The detailed study of all pathologies that cause corneal alteration is unapproachable, so we have centered our interest in the most prevalent or characteristic of them. In this paper we have divided these pathologies in sections to facilitate their study. Pulmonar and conective tissue (like colagen, rheumatologic and idiopathic inflamatory diseases), dermatologic, cardiovascular, hematologic, digestive and hepatopancreatic diseases with corneal alteration are described. Endocrine and metabolic diseases, malnutrition and carential states are also studied, as well as some otorhinolaryngologic and genetic diseases that affect the cornea. Finally, a brief report of ocular toxicity induced by drugs is referred.

Excimer laser-assisted anterior lamellar keratoplasty for keratoconus, corneal problems after laser in situ keratomileusis, and corneal stromal opacities.

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Bilgihan, Kamil; Ozdek, Sengül C; Sari, Ayça; Hasanreisoğlu, Berati

2006-08-01

To evaluate excimer laser-assisted anterior lamellar keratoplasty to augment thin corneas as in keratoconus ( .05). This technique presents a different modality for the treatment of keratoconus, post-LASIK corneal problems, and other corneal stromal opacities with anterior lamellar keratoplasty. Additional studies with more patients and longer follow-up will help determine the role of this technique as a substitute for penetrating keratoplasty in these patients.

Research on inhibition of corneal neovascularization

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Zhang-Hui Yang

2015-12-01

Full Text Available Corneal transparency is the basis of the normal physiological functions.However, corneal neovascularization(CNVmay occur in the infection, mechanical and chemical injury or under other pathological conditions,which make the cornea lose original transparency and severe visual impairment. In recent years, along with the development of immunology, molecular biology, biochemistry and other disciplines, there is more in-depth understanding on the CNV, and clinical treatment of CNV has made new breakthroughs. This article provides an overview of the inhibition of CNV.

Differentiation of mild keratoconus from corneal warpage according to topographic inferior steepening based on corneal tomography data

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Lia Florim Patrão

Full Text Available ABSTRACT We report two cases of suspicious asymmetric bow tie and inferior steepening on topographic evaluations with reflection (Placido and projection (Scheimpflug. Rotating Scheimpflug corneal and anterior segment tomography (Oculus Pentacam HR, Wetzlar, Germany® was performed in the first case, with a maximal keratometric value (Kmax of 43.2 D and an overall deviation value from the Belin/Ambrósio Enhanced Ectasia Display (BAD-D of 1.76, which was observed in the study eye (OD. BAD-D was 6.59 in the fellow eye, which had clinical findings that were consistent with keratoconus stage 2. The second case presented with a Kmax of 45.3 D and BAD-D of 0.76 in OD and 1.01 in OS. This patient had discontinued wearing soft contact lens less than 1 day prior to examination. Corneal tomographic data enabled us to distinguish mild or forme fruste keratoconus from contact lens-induced corneal warpage, and similar findings were observed on curvature maps.

Dynamic ultra high speed Scheimpflug imaging for assessing corneal biomechanical properties

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Renato Ambrósio Jr

2013-04-01

Full Text Available OBJECTIVE: To describe a novel technique for clinical characterization of corneal biomechanics using non-invasive dynamic imaging. METHODS: Corneal deformation response during non contact tonometry (NCT is monitored by ultra-high-speed (UHS photography. The Oculus Corvis ST (Scheimpflug Technology; Wetzlar, Germany has a UHS Scheimpflug camera, taking over 4,300 frames per second and of a single 8mm horizontal slit, for monitoring corneal deformation response to NCT. The metered collimated air pulse or puff has a symmetrical configuration and fixed maximal internal pump pressure of 25 kPa. The bidirectional movement of the cornea in response to the air puff is monitored. RESULTS: Measurement time is 30ms, with 140 frames acquired. Advanced algorithms for edge detection of the front and back corneal contours are applied for every frame. IOP is calculated based on the first applanation moment. Deformation amplitude (DA is determined as the highest displacement of the apex in the highest concavity (HC moment. Applanation length (AL and corneal velocity (CVel are recorded during ingoing and outgoing phases. CONCLUSION: Corneal deformation can be monitored during non contact tonometry. The parameters generated provide clinical in vivo characterization of corneal biomechanical properties in two dimensions, which is relevant for different applications in Ophthalmology.

Reactivation of Herpes Zoster Keratitis With Corneal Perforation After Zoster Vaccination.

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Jastrzebski, Andre; Brownstein, Seymour; Ziai, Setareh; Saleh, Solin; Lam, Kay; Jackson, W Bruce

2017-06-01

We present a case of reactivated herpes zoster keratouveitis of 6 years duration with corneal perforation requiring penetrating keratoplasty shortly after inoculation with herpes zoster vaccine (Zostavax, Merck, Quebec, Canada). Retrospective case report. A 67-year-old woman with a 5-year history of recurrent unilateral herpes zoster keratouveitis in her right eye presented with another recurrence 2 weeks after Zostavax vaccination. Three months later, she developed descemetocele and 2 months afterward, corneal perforation, which was managed by penetrating keratoplasty. Immunohistopathological examination disclosed positive staining for varicella zoster virus in most of the keratocytes adjacent to the descemetocele and perforation, most vividly in the deeper two-thirds of the stroma where the keratocytes were most dense, but not in corneal epithelium or endothelium. Electron microscopic examination showed universally severely degenerated corneal keratocytes in the corneal stroma adjacent to the perforation with variable numbers of herpes virus capsids present in half of these cells. Only a rare normal-appearing keratocyte was identified in the more peripheral corneal stroma. We present a case of reactivation of herpes keratouveitis shortly after vaccination with Zostavax in a patient with previous herpes zoster ophthalmicus. We demonstrate, for the first time, ultrastructural evidence consistent with inactive virus capsids in diffusely degenerated keratocytes in the extracted corneal tissue.

Evaluation of corneal changes after myopic LASIK using the Pentacam®

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Khairat YM

2013-09-01

Full Text Available Yehia M Khairat, Yasser H Mohamed, Ismail ANO Moftah, Narden N Fouad Department of Ophthalmology, Faculty of Medicine, El-Minya University, Egypt Background: In this study, we used a Pentacam® device to evaluate the corneal changes that occur after laser-assisted in situ keratomileusis (LASIK. Methods: Our study included 60 eyes of 32 patients. All patients were treated for myopia and myopic astigmatism using LASIK. The eyes were examined preoperatively and 3 months postoperatively using a Pentacam to assess corneal changes with regard to curvature, elevation, and asphericity of the cornea. Results: A statistically significant decrease in mean keratometric power of the anterior corneal surface (P = 0.001 compared with its pre-LASIK value was detected after 3 months, but there was no significant change in keratometric power of the posterior surface (P = 0.836. Asphericity (Q-value of the anterior and posterior surfaces increased significantly after LASIK (P = 0.001. A significant forward bulge of the anterior corneal surface 4 mm and 7 mm from the central zone was detected 3 months post-LASIK (P = 0.001 for both, but there was no significant increase in posterior elevation at 4 mm and 7 mm from the center (P = 0.637 and P = 0.26, respectively. No cases of post-LASIK ectasia were detected. Correlation between different parameters of the corneal surface revealed an indirect relation between changes in pachymetry and anterior corneal elevation at 4 mm and 7 mm from the central zone (r = −0.27, P = 0.13, and r = −0.37, P = 0.04, respectively, and a direct proportion between changes in pachymetry and mean keratometric power of the anterior and posterior corneal surfaces (r = 0.7, P = 0.001 and r = 0.4, P = 0.028, respectively. Conclusion: LASIK causes significant changes at the anterior corneal surface but the effect is subtle and insignificant at the posterior surface. Keywords: LASIK, laser-assisted in situ keratomileusis, Pentacam®, corneal

A Clinical Microbiological Study of Corneal Ulcer Patients at Western Gujarat, India

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Nilesh Dhanjibhai Patel

2013-06-01

Full Text Available Corneal ulcer is a major cause of blindness throughout the world. When the cornea is injured by foreign particles, there are chances of infection by the organism and development of ulcer. Bacterial infection in the cornea is invariably an alteration of the defense mechanism of the outer eye. It is essential to determine the local etiology within a given region when planning a corneal ulcer management strategy. Laboratory evaluation is necessary to establish the diagnosis and to guide the antibiotic therapy. One hundred corneal ulcer patients were studied by collecting their corneal scraping samples and processing at Clinical Microbiology department of Shree Meghaji Petharaj Shah Medical College, Jamnagar, Gujarat, India during a period of 17 months. All clinical microbiology laboratory procedures followed standard protocols described in the literature. 40 (40% patients from the age group of 20-70 years had been confirmed as - any organism culture positive - within the corneal ulcer patient population. Fungi were isolated from 26 (26% corneal ulcer patients. The bacterial etiology was confirmed in 14 (14% corneal ulcer patients. The major risk factors for mycotic keratitis were vegetative injury (16, (62%, followed by conjunctivitis (4, (15%, and blunt trauma (3, (11%. Pseudomonas aeruginosa was the most commonly isolated bacterium (6, (43%, followed by Proteus spp. (4, (29%. Corneal Infections due to bacteria and filamentous fungi are a frequent cause of corneal damage. Microbiological investigation is an essential tool in the diagnosis of these infections. The frequency of fungal keratitis has risen over the past 20 to 30 years. Prognosis of bacterial corneal infection has improved since the introduction of specific antibacterial therapy.

A clinical microbiological study of corneal ulcer patients at western Gujarat, India.

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Rajesh Somabhai Katara

2013-06-01

Full Text Available Corneal ulcer is a major cause of blindness throughout the world. When the cornea is injured by foreign particles, there are chances of infection by the organism and development of ulcer. Bacterial infection in the cornea is invariably an alteration of the defense mechanism of the outer eye. It is essential to determine the local etiology within a given region when planning a corneal ulcer management strategy. Laboratory evaluation is necessary to establish the diagnosis and to guide the antibiotic therapy. One hundred corneal ulcer patients were studied by collecting their corneal scraping samples and processing at Clinical Microbiology department of Shree Meghaji Petharaj Shah Medical College, Jamnagar, Gujarat, India during a period of 17 months. All clinical microbiology laboratory procedures followed standard protocols described in the literature. 40 (40% patients from the age group of 20-70 years had been confirmed as - any organism culture positive - within the corneal ulcer patient population. Fungi were isolated from 26 (26% corneal ulcer patients. The bacterial etiology was confirmed in 14 (14% corneal ulcer patients. The major risk factors for mycotic keratitis were vegetative injury (16, (62%, followed by conjunctivitis (4, (15%, and blunt trauma (3, (11%. Pseudomonas aeruginosa was the most commonly isolated bacterium (6, (43%, followed by Proteus spp. (4, (29%. Corneal Infections due to bacteria and filamentous fungi are a frequent cause of corneal damage. Microbiological investigation is an essential tool in the diagnosis of these infections. The frequency of fungal keratitis has risen over the past 20 to 30 years. Prognosis of bacterial corneal infection has improved since the introduction of specific antibacterial therapy.

Corneal complications and visual impairment in vernal keratoconjunctivitis patients

International Nuclear Information System (INIS)

Arif, A.S.; Aaqil, B.; Siddiqui, A.; Nazneen, Z.; Farooq, U.

2017-01-01

Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients. Methods: This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities. Results: The mean age of presentation was 10.83+-6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus. Conclusion: Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment. (author)

Corneal biomechanical properties after laser-assisted in situ keratomileusis and photorefractive keratectomy

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Hwang ES

2017-10-01

Full Text Available Eileen S Hwang,1 Brian C Stagg,1 Russell Swan,1 Carlton R Fenzl,1 Molly McFadden,2 Valliammai Muthappan,1 Luis Santiago-Caban,1 Mark D Mifflin,1 Majid Moshirfar1,3 1Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, 2Department of Internal Medicine, University of Utah, Salt Lake City, 3HDR Research Center, Hoopes Vision, Draper, UT, USA Background: The purpose of this study was to evaluate the effects of laser-assisted in situ keratomileusis (LASIK and photorefractive keratectomy (PRK on corneal biomechanical properties.Methods: We used the ocular response analyzer to measure corneal hysteresis (CH and corneal resistance factor (CRF before and after refractive surgery.Results: In all, 230 eyes underwent LASIK and 115 eyes underwent PRK without mitomycin C (MMC. Both procedures decreased CH and CRF from baseline. When MMC was used after PRK in 20 eyes, it resulted in lower corneal biomechanical properties at 3 months when compared to the other procedures, but all three procedures had similar values at 12 months.Conclusion: Significant but similar decreases in corneal biomechanical properties after LASIK, PRK without MMC, and PRK with MMC were noted. Keywords: corneal biomechanics, photorefractive keratectomy, laser-assisted in situ keratomileusis, corneal hysteresis, corneal resistance factor, mitomycin C

Changes in corneal sensitivity following cross-linking for progressive early-stage keratoconus

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Anelise de Medeiros Lago

2014-04-01

Full Text Available Purpose: To evaluate changes in corneal sensitivity following corneal cross-linking (CXL in patients with progressive earlier stage keratoconus. Methods: Thirty-eight eyes of 19 patients (11 women, 8 men were included in a prospective, nonrandomized clinical study. The mean patient age was 22 years (range, 18-26 years. Inclusion criteria were early stage bilateral progressive keratoconus, a transparent cornea, and a thickness of ≥440 µm in the thinnest area of the cornea. Using the Cochet-Bonnet esthesiometer, central corneal sensitivity was measured before surgery, 7 days after surgery, and once a month thereafter until recovery of baseline preoperative levels. Central corneal sensitivity >40 mm was considered normal. Results: Corneal sensitivity gradually returned to preoperative levels in all treated eyes. The mean central corneal sensitivity was 52.2, 24.0, 38.2, 42.5, 50.0, and 52.5 mm before surgery, 7 days after surgery, and at 1, 2, 3, and 4 months after surgery, respectively. Normal levels of corneal sensation, but not baseline (preoperative levels, were observed 2 months after surgery. The preoperative levels were observed 3 months after surgery. Conclusions: Our results suggest that central corneal sensitivity can be decreased for as long as 3 months after CXL for progressive earlier stage keratoconus.

A Rare Form of Corneal Opacity Associated with Spondyloepiphyseal Dysplasia Congenita

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Yuichiro Ishida

2018-02-01

Full Text Available A 13-year-old Japanese female diagnosed with spondyloepiphyseal dysplasia congenita (SEDC was referred for ophthalmologic evaluation. Examination with slit-lamp and optical coherence tomography revealed bilateral thin cornea with diffuse corneal opacity which was localised at the posterior stromal depth in the central cornea. Unlike the two previously reported cases of diffuse and nodular patterns of corneal opacity in SEDC, the current case exhibited a rare form of corneal opacity. SEDC is one of the type II collagenopathies, characterised by dwarfism because the mutations in COL2A1 prevent bone growth. Although the existence of type II collagen has not been reported in the human corneal stroma, the aetiology of the opacity in the corneal stroma in SEDC type II collagenopathy is of interest.

Femtosecond laser-assisted keratoplasty in a child with corneal opacity:case report

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E. Yu. Markova

2014-01-01

Full Text Available Corneal opacities are the fourth cause of blindness world-wide. Over the past two centuries, various corneal transplantation (i.e., keratoplasty methods have been developed and improved. Nowadays, femtolaserssisted keratoplasty is one of most promising techniques. Femtosecond laser have several advantages that provide additional surgical benefits. Among them, no thermal injury, the ability to cut deeply on a single plane and to perform various corneal profiles should be mentioned. In children, corneal disorders are of special importance while femtosecondassisted keraatoplasty case reports are rare. Here, we describe femtosecond laserssisted penetrating keratoplasty in a girl with a rough central corneal opacity.

Acute Corneal Hydrops in Children with Primary Infantile Glaucoma: A Report of 31 Cases over 23 Years at the LVPEI.

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Anil K Mandal

Full Text Available Relatively little data exist regarding the outcomes of children with primary infantile glaucoma presenting with acute corneal hydrops. The aim of our study was to determine the surgical outcome of children of infantile glaucoma who presented with acute corneal hydrops.In total, 38 eyes of 31 consecutive children of infantile glaucoma presented with acute corneal hydrops who underwent primary combined trabeculotomy-trabeculectomy (CTT by a single surgeon from January 1990 to December 2012 at the LV Prasad Eye Institute (LVPEI, a tertiary eye care centre in Southern India were enrolled in this retrospective study. Primary outcome measures were intraocular pressure (IOP control (IOP ≤ 16 mmHg under anaesthesia or IOP ≤ 21 mmHg without anaesthesia and clearance of corneal edema. Secondary outcome measures were visual acuity (VA, corneal diameter, bleb appearance, intraoperative and postoperative complications.Mean age at presentation was 6.4 months (range, 2-11 months and seven eyes (23% had bilateral affliction. At presentation, all eyes (100% had moderate to severe degree of corneal edema with a mean preoperative IOP of 25.6 ±5.1 mmHg. Postoperatively, the IOP reduced to 12.0 ± 3.8 mmHg (difference = -13.6, 95% CI = -15.7 to -11.5, t = -13.18, p<0.0001, and the percentage reduction in IOP was 53.05%. Preoperatively 83% of the eyes were on antiglaucoma medication, and postoperatively 2 eyes (5.3% required 1 antiglaucoma medication for control of IOP. Preoperatively, corneal edema was present in all eyes and postoperatively it cleared in all of them. Significant myopic astigmatism was present in 28 eyes (74%, the commonest being compound myopic astigmatism (75% followed by simple myopic astigmatism (21%. Normal VA (best-corrected VA; BCVA ≥ 20/60 was achieved in 44.4% of the eyes and 22.2% eyes had low vision (BCVA, <20/60 to 20/400. Complete success (IOP control and clearance of corneal oedema was obtained in 94.7% eyes. There were no

Edge detection and mathematic fitting for corneal surface with Matlab software.

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Di, Yue; Li, Mei-Yan; Qiao, Tong; Lu, Na

2017-01-01

To select the optimal edge detection methods to identify the corneal surface, and compare three fitting curve equations with Matlab software. Fifteen subjects were recruited. The corneal images from optical coherence tomography (OCT) were imported into Matlab software. Five edge detection methods (Canny, Log, Prewitt, Roberts, Sobel) were used to identify the corneal surface. Then two manual identifying methods (ginput and getpts) were applied to identify the edge coordinates respectively. The differences among these methods were compared. Binomial curve (y=Ax 2 +Bx+C), Polynomial curve [p(x)=p1x n +p2x n-1 +....+pnx+pn+1] and Conic section (Ax 2 +Bxy+Cy 2 +Dx+Ey+F=0) were used for curve fitting the corneal surface respectively. The relative merits among three fitting curves were analyzed. Finally, the eccentricity (e) obtained by corneal topography and conic section were compared with paired t -test. Five edge detection algorithms all had continuous coordinates which indicated the edge of the corneal surface. The ordinates of manual identifying were close to the inside of the actual edges. Binomial curve was greatly affected by tilt angle. Polynomial curve was lack of geometrical properties and unstable. Conic section could calculate the tilted symmetry axis, eccentricity, circle center, etc . There were no significant differences between 'e' values by corneal topography and conic section ( t =0.9143, P =0.3760 >0.05). It is feasible to simulate the corneal surface with mathematical curve with Matlab software. Edge detection has better repeatability and higher efficiency. The manual identifying approach is an indispensable complement for detection. Polynomial and conic section are both the alternative methods for corneal curve fitting. Conic curve was the optimal choice based on the specific geometrical properties.

Corneal topography measurements for biometric applications

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Lewis, Nathan D.

The term biometrics is used to describe the process of analyzing biological and behavioral traits that are unique to an individual in order to confirm or determine his or her identity. Many biometric modalities are currently being researched and implemented including, fingerprints, hand and facial geometry, iris recognition, vein structure recognition, gait, voice recognition, etc... This project explores the possibility of using corneal topography measurements as a trait for biometric identification. Two new corneal topographers were developed for this study. The first was designed to function as an operator-free device that will allow a user to approach the device and have his or her corneal topography measured. Human subject topography data were collected with this device and compared to measurements made with the commercially available Keratron Piccolo topographer (Optikon, Rome, Italy). A third topographer that departs from the standard Placido disk technology allows for arbitrary pattern illumination through the use of LCD monitors. This topographer was built and tested to be used in future research studies. Topography data was collected from 59 subjects and modeled using Zernike polynomials, which provide for a simple method of compressing topography data and comparing one topographical measurement with a database for biometric identification. The data were analyzed to determine the biometric error rates associated with corneal topography measurements. Reasonably accurate results, between three to eight percent simultaneous false match and false non-match rates, were achieved.

A review of teaching methods and outcomes of resident phacoemulsification.

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Kaplowitz, Kevin; Yazdanie, Mohammad; Abazari, Azin

Cataract surgery with phacoemulsification is a challenging procedure for surgeons in training to learn to perform safely, efficiently, and effectively. We review the auxiliary learning tools outside the operating room that residency programs have incorporated into their curriculum to improve surgical skills, including wet laboratory and surgical simulators. We then discuss different methods of teaching cataract surgery in the operating room. Our goal is to define a learning curve for cataract surgery. We demonstrate that complication rates decline significantly after a resident performs an average of 70 cases. We summarize the reported incidence and risk factors for complications in resident-performed cataract surgery to help identify cases that require a higher level of skill to improve visual outcomes. We suggest that future studies include details on preoperative comorbidities, risk stratification, resident skill level, and frequency of takeover by attending. Published by Elsevier Inc.

Infiltrados corneales asociados al uso de lentes de contacto Corneal infiltrates associated with contact lens wear

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Vivian Padrón Álvarez

2001-12-01

Full Text Available Se estudiaron 15 pacientes que usan lentes de contacto rígidas, permeables al gas (LCRPG y lentes de contacto blandas (LCB que presentaron infiltrados corneales. Se realizó estudio microbiológico de las lesiones y seguimiento clínico de estos casos. En 3 de los casos estudiados el cultivo fue positivo a estafilococo aureus, el resto de los estudios microbiológicos fueron negativos. Todos los pacientes respondieron rápidamente al retirar la lente de contacto y al tratamiento con antibióticos tópicos y ninguno tuvo afectación permanente de la agudeza visual. El diagnóstico exacto y el manejo apropiado de los infiltrados corneales en pacientes que usan lentes de contacto es de gran importancia por la posibilidad de infección o de secuela visual permanente.15 patients wearing gas permeable rigid contact lenses (GPRCL and soft contanct lenses (SCL that presented corneal infiltrates were studied. A microbiological study of the injuries and a clinical follow-up of these cases were conducted. In 3 of the studied cases the culture was positive to Staphyloccocus aureus. The rest of the mircobiological studies were negative. All the patients responded rapidly to the contact lens removal and to the treatment with topical antibiotics. None of them had permanent affection of visual acuity. The accurate diagnosis and the appropiate management of the corneal infiltrates in patients wearing contact lenses is very important due to the possibility of infection or of permanent visual sequela.

The application of excimer lasers for corneal sculpturing

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King, M.C.

1990-01-01

Of the broad selection of lasers available for surgery, the argon fluoride excimer laser offers a set of attributes that make it uniquely suited for the removal of corneal tissue. With ultraviolet radiation at 193mm, the energy of an individual photon (6.3 electron volts) is sufficient to break bonds in protein molecules without generating molecular vibration (heat). A single laser pulse is capable of removing 0.25 microns of corneal tissue over a well defined area 80 mm 2 in extent. This excision with a lateral precision to a fraction of a micron causes no discernible damage to neighboring cells. The smooth surface left after the tissue is removed promotes a quick and predictable regrowth of the epithelium. The penetration of radiation into the underlying tissue is the order of a micron so there is no potential harm to the lens or retinal tissue. Insignificant mutagenesis or unscheduled DNA synthesis has been detected as a result of tissue irradiation at this wavelength. In the past few years major progress has been made towards developing ophthalmic procedures which utilize the unique properties of this laser. To date there are FDA IDE's (Investigational Device Exemptions) for the following procedures: Photorefractive Keratectomy (PRK) or corneal reshaping for correcting near-sightedness, far-sightedness and astigmatism without the need for eye glasses, contact lenses or conventional refractive surgery (Radial Keratotomy); Partial Excimer Trabeculectomy for relieving the pressure build-up caused by glaucoma; T-Excisons for reducing astigmatism; Myopic Keratomileusis (MKM) for the refractive correction of severe myopia; superficial Keratectomy (corneal smoothing) for treating various corneal scars, dystrophies, recurrent corneal erosion etc. In this paper the fundamentals of beam tissue interaction at 193nm will be discussed

21 CFR 886.1450 - Corneal radius measuring device.

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2010-04-01