Abstract Purpose The purpose of this study was to evaluate early visual and refractive outcomes of Descemet's stripping endothelial keratoplasty (DSAEK). Method Nine eyes of 7 male and 2 female ...patients, mean age 73 years, were treated with DSAEK. Eight had pseudophakic bullous keratopathy and 1 had advanced Fuch's syndrome. Patients were followed up for a mean of 11.4 months (range, 4–26). The DSAEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea using the Tan EndoGlide. The mean operating time was 61.89 minutes (standard deviation SD, 9.3). Results The median donor diameter was 8.375 mm (range, 8.25–8.75) and the mean donor thickness was 114.4 μm (range, 98–129). Mean preoperative sphere was −2.41 that changed postoperatively in −1.21. Mean endothelial cell loss was 25% (range, 23%–45%) at 6 months after surgery. Corneal pachymetry was reduced from 796.6 μm preoperatively to 535.5 μm postoperatively. Best corrected vicual acuity (BCVA) was 20/40 or better postoperatively and exceeded the preoperative BCVA in all eyes. No graft failure was present. Two partial graft dislocations (1st and 5th postoperative day) were observed. One graft was successfully attached after reinjecting an air bubble (rebubbling) in the anterior chamber and the other graft was reattached with 4 10/0 nylon sutures after failed rebubbling. Conclusions The key to successful endothelial transplantation is the protection and preservation of as many donor endothelial cells as possible. The TAN EndoGlide is a device that consistently delivers a donor lenticule through a small incision with minimal endothelial loss, while making the insertion procedure relatively reliable and consistent, with the surgeon in full control of the donor at all stages of insertion. The endothelial cell loss during this technique is comparable (if not better) with other endothelial graft insertions systems.
The work has been presented at The Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Fort Lauterdale, Florida, May 1999.
To evaluate inter- and intraobserver variability of ...the R/D score in assessing the iris configuration in Pigment Dispersion Syndrome patients.
Fifty-seven high-resolution ultrasound biomicroscopy images were obtained by a single ophthalmologist. All images were examined twice by each of three ophthalmologists, the second assessment being at least 2 weeks after the first. Each observer was masked to their colleagues' and their previous measurements. R/D scores were calculated at each examination. Agreement between and amongst observers was assessed using Bland-Altman plots. In addition, the R/D scores were categorised and reassessed using the Kappa statistic.
Intraobserver variability was small, the average differences between first and second scores of each observer being less than 0.01 units. Agreement within observers was 89% or higher, with Kappa values of 0.8 or higher, indicating almost perfect agreement. Interobserver variability was, however, greater. Although there was substantial agreement between two of the observers (87% agreement, first assessment; 80%, second assessment with respective kappa statistics of 0.78 and 0.66), they only moderately agreed with the other observer (kappa statistics between 0.55 and 0.68).
This study suggests that when using R/D scores to demonstrate changes in iris configuration, assessments should preferably be made by the same observer.
This study was conducted in order to investigate the effect of accommodation on the iris morphology and iridolenticular contact, in eyes with Pigment Dispersion Syndrome and Pigmentary Glaucoma, ...using high-resolution ultrasound.
We performed a prospective observational study, examining a group of 30 Pigment Dispersion Syndrome and Pigmentary Glaucoma patients (49 eyes) and a smaller group of eight 'normals' non-Pigment Dispersion Syndrome patients (8 eyes). All patients underwent ultrasound biomicroscopy, before and during accommodation.
The iris profile before accommodation was found convex in 48.5%, flat in 19.7% and concave in 31.8%. Following accommodation the iris configuration remained unchanged in 66.2%, increased in concavity in 20.3% and decreased in concavity in 13.5%.
The effect of accommodation on iris configuration and accommodation is highly variable. From our experience the measurement of iris configuration using ultrasound biomicroscopy may not be a useful method of evaluating the effect of different treatments on iris configuration.
One of the restrictive measures of COVID-19 (coronavirus disease 2019) pandemic control is the prohibition of accompanied clinic visits. The specific features of ophthalmological patients imply ...different degrees of dependency that directly affect their response to such measures. This study aims to assess the effects of unaccompanied medical appointments on outpatients’ stress levels and their retention of medical advice.
A questionnaire-based survey was conducted at a large ophthalmic clinic in northern Greece during September 2020. Suitable subjects were asked to self-administer a 7-item questionnaire addressing their subjective perception of stress and their ability to fully understand and remember their doctor's instructions, given the fact that they would be alone during the consultation. The analysis was based on 200 patients who completed the survey. Sixty-three patients (31.5%) reported that unaccompanied clinic visits increased their stress, with a median value of 7.5 (mean 6.77 ± .2.7) on a scale from 1 to 10. A large number of the patients (30%) claimed it was difficult to remember the doctor's comments or instructions, and 24.6% indicated that they would not fully understand them if they were to attend the clinic unaccompanied. A marked impact on women and on the elderly (up to threefold) over 70 years of age was identified. This is the first study specifically addressing practical repercussions of unaccompanied clinic visits during the COVID-19 pandemic. A negative effect on patients’ emotional status and on counseling effectiveness was demonstrated. Female gender and advanced age were found to be determinants of the highest vulnerability.
We evaluated the safety and efficacy of the non-contact holmium:YAG laser thermal keratoplasty (LTK) for the treatment of mild to moderate hyperopia without astigmatism.
A prospective, ...non-comparative case series included 50 eyes of 28 patients (aged > or =40 years) who had stable refraction and an astigmatic component < +0.50 diopters (D). We applied the non-contact pulsed holmium:YAG laser to treat the hyperopic spherical component using the Hyperion LTK System. All patients had minimum 12-month follow-up and 64% (18 patients) had 24-month follow-up.
The mean age of patients was 48.4 +/- 8.23 years (range: 40 to 62 years). The preoperative hyperopic mean spherical equivalent refraction was +2.32 +/- 0.975 D (range: +1.00 to +4.75 D). Postoperatively, the subjective manifest refraction decreased from the preoperative mean value of +2.32 D to a mean -0.09 D at 1 month after surgery and regressed to +0.315 D at the last follow-up examination, resulting in a mean correction of +2.005 +/- 0.81 D at 24 months after surgery. Preoperatively, mean uncorrected visual acuity in LogMAR units was 0.798 +/- 0.353 and at 12 months after surgery, it was a mean 0.108 +/- 0.136. Keratometric power increased from 42.595 +/- 1.949 D before surgery to 44.605 +/- 1.626 D at 24 months after surgery.
Holmium:YAG LTK was an acceptable alternative for the correction of mild to moderate hyperopia in this middle-aged population.
To evaluate the safety of implanting a 3-piece, 6.0 mm optic, foldable acrylic intraocular lens (IOL) in cases of posterior capsule rupture during phacoemulsification.
Department of Ophthalmology, ...Ahepa Hospital, Aristotle University Medical School, and Interbalkan Medical Center, Thessaloniki, Greece.
This prospective noncomparative case series included 28 eyes (28 patients) having phacoemulsification complicated by extensive posterior capsule rupture with or without vitreous loss. In all eyes, a 3-piece, 6.0 mm optic, foldable acrylic IOL (AcrySof® MA60BM, Alcon) was implanted in the sulcus. Postoperative examination included best corrected visual acuity (BCVA), anterior segment biomicroscopy, IOL centration and position, intraocular pressure (IOP), and fundus biomicroscopy. The follow-up was 6 months.
The most common postoperative complications were transient corneal edema in 12 eyes and increased IOP in 11 eyes. Slight asymptomatic decentration from the center of the pupil (1.0 to 2.0 mm) and pseudophacodonesis were observed in 5 eyes each. Friction of the IOL with the iris occurred in 1 eye. Clinically significant cystoid macular edema occurred in 3 eyes. The final BCVA was between 20/15 and 20/25 in 18 patients, 20/30 in 2, between 20/40 and 20/50 in 4, and between 20/60 and 20/200 in 4.
AcrySof IOL implantation in the sulcus during phacoemulsification complicated by posterior capsule rupture preserved the advantages of small-incision surgery. The postoperative behavior and centration of the IOLs resembled those of poly(methyl methacrylate) lenses.
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