Stabilization Period of Central Corneal Thickness, Anterior Chamber Depth and Iridocorneal Angle Parameters After Deep Anterior Lamellar Keratoplasty in Keratoconus Patients

ulusoy, gönül karatas

doi:10.14744/bej.2021.70894

Cited by 5 publications

(5 citation statements)

References 24 publications

(35 reference statements)

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“…Other studies have reported visual and refractive stabilization 6 months after complete suture removal in patients who underwent DALK for keratoconus, whose refractive outcomes remained stable during a follow-up of up to 5 years. [19][20][21][22][23] However, Alvarez de Toledo et al 17 reported an initial stabilization of astigmatism after PK along the first 7 to 10 years after complete suture removal in patients with keratoconus, followed by progressive refractive and keratometric changes, with a tendency to increase myopic astigmatism, in over 50% of the patients during a followup of between 15 and 25 years. Predictability of our refractive results was similar to Lockington et al, 3 with a mean cylinder prediction error of 1.61 6 1.35 D (compared with 1.63 6 1.5 D ( 11)) and 62% of eyes within 1.5 D of the intended cylinder (Fig.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism

Moreno-Martínez¹,

Martín-Melero²,

Andrés-Pretel³

et al. 2023

Cornea

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Purpose:The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism.Methods:This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation.Results:Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2–13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2–12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from −5.30 ± 1.86 D to −1.62 ± 1.94 D (P < 0.001) and from −4.00 ± 4.46 D to −0.25 ± 1.25 D (P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P< 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively.Conclusions:Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism

Moreno-Martínez¹,

Martín-Melero²,

Andrés-Pretel³

et al. 2023

Cornea

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“…Corneal transplantation has been the traditional treatment for advanced corneal diseases. It is considered the final option for patients who cannot tolerate or benefit from conservative treatments [37 ▪ ].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

“…Indications for lamellar keratoplasty include contact-lens intolerant patients without significant Descemet membrane scarring from hydrops [2]. Patients should have an intact Descemet membrane for deep anterior lamellar keratoplasty (DALK), as it involves replacement of diseased corneal stroma while preserving healthy endothelium [37 ▪ ,38 ▪ ]. Because it preserves the host endothelium, DALK eliminates the risk of endothelial rejection and cell loss associated with that of penetrating keratoplasty.…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Indications for keratoplasty in management of corneal ectasia

Choi¹,

Jeng²

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review aims to describe recent advancements in treatment of corneal ectasias and its effect on indications for corneal transplantation.Recent findingsThe majority of patients affected by ectatic corneal disease use contact lenses to correct resulting astigmatism. Patients who are intolerant of contact lenses or cannot achieve acceptable vision through conservative measures could consider keratoplasty. However, continuing advancements in both nonsurgical and surgical treatments are either reducing or delaying the need for keratoplasty in patients affected by ectatic corneal disease.SummaryCorneal transplantation has been the mainstay of treatment for patients with advanced ectatic corneal disease. In the past decade, numerous improvements have been occurred to make contact lenses not only more effective for visual correction, but also more comfortable. Although corneal cross-linking is the only proven treatment known to prevent progression of disease, several other therapies show early potential for those in which cross-linking is contraindicated. Patients now have access to a wider range of therapies before considering keratoplasty.

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“…Refractive procedures should be carried out in eyes that have had prior keratoplasty once the corneal shape and refraction have stabilized. A minimum of one month should elapse between refractive surgery and all suture removal, with a three-to-six-month period following suture removal being ideal, according to several studies [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Astigmatism after Keratoplasty: A Systematic Review Meta-Analysis Based on PRISMA

Kijonka,

Nowińska,

Wylęgała

et al. 2024

JCM

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Background: The number of corneal transplants is rising, with the aim to treat a spectrum of diseases ranging from dystrophies to corneal opacities caused by trauma or chemical burns. Refractive outcomes after this procedure are often impossible to predict and associated with high levels of astigmatism. However, there are many techniques that affect the reduction of astigmatism and improve the quality of life of patients. Objectives: The aim was to compare the improvement in postoperative visual acuity (logMAR) and amount of corneal astigmatism (Diopters) after corneal keratoplasty in patients who additionally underwent a surgical procedure, which affects the reduction in postoperative astigmatism, and to determine the most effective method. Search Methods and Selection Criteria: A thorough search was carried out across online electronic databases including PubMed, Embrase, Ovid MEDLINE, Scopus, and Web of Science, using combinations containing the following phrases: postoperative astigmatism, post-keratoplasty astigmatism, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), posterior lamellar keratoplasty, endothelial keratoplasty (EK), penetrating keratoplasty (PK), corneal transplant, keratoplasty, refractive surgery, kerato-refractive surgery, laser in situ keratomileusis (LASIK), and femtosecond LASIK. This was to determine all English-language publications that discuss refractive operations for postoperative or post-keratoplasty astigmatism. These bibliographies were searched for English-language publications published between 2010 and 2023. We proceeded to review each detected record’s reference list. Data Extraction: Study characteristics such as study design, sample size, participant information, operations performed, and clinical outcomes were all extracted. Data Statistical Analyses: The Comprehensive Meta-Analysis software (version 3.3.070, 2014) was used to perform the analysis. The threshold of 0.05 for p-values was considered statistically significant. All effect sizes are reported as standardized differences (Std diff) in means with a 95% confidence interval (CI) and visualized graphically as forest plots. Publication bias is presented as a funnel plot of standard error by Std diff in means. Four methods were used to evaluate the heterogeneity among the studies: Q-value, I2, chi-square (χ2), and tau-squared. Main Results: We included 21 studies that randomized 1539 eyes that underwent corneal transplantation surgery either by PKP, DALK, or DSEAK techniques. The results showed the most significant improvement in the visual acuity and significant decrease in the corneal astigmatism after laser surgery procedures, like femtosecond-assisted keratotomy after DALK and PKP and LASIK after DSEAK.

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Stabilization Period of Central Corneal Thickness, Anterior Chamber Depth and Iridocorneal Angle Parameters After Deep Anterior Lamellar Keratoplasty in Keratoconus Patients

Cited by 5 publications

References 24 publications

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism

Indications for keratoplasty in management of corneal ectasia

Postoperative Astigmatism after Keratoplasty: A Systematic Review Meta-Analysis Based on PRISMA

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