Stepwise Guided Photorefractive Keratectomy in Treatment of Irregular Astigmatism After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Sorkin, Nir; Einan‐Lifshitz, Adi; Abelson, Sagi; Boutin, Tanguy; Showail, Mahmood; Borovik, Armand; Ashkenazy, Zach; Chan, Clara C.; Rootman, David S.

doi:10.1097/ico.0000000000001359

Cited by 24 publications

(48 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Acar et al15 also described a significant improvement in UDVA with LASIK after DALK, without eyes losing CDVA lines. Recently, Sorkin et al14 reported a significant improvement in CDVA and UDVA in 34 eyes submitted to PRK postkeratoplasty. Comparing to phakic IOLs, corneal ablation procedures carry a relatively high rate of complications, such as corneal graft haze and regression of treatment, offer less predictable results and may not fully correct large degrees of spherical and astigmatic refractive errors 8,19–23…”

Section: Discussionmentioning

confidence: 99%

“…Several surgical options to correct refractive errors after DALK have been reported in the literature, such as PRK,13,14 LASIK,15,16 small incision lenticule extraction17 and corneal relaxing incisions 18. In addition, phakic IOLs implantation have also been satisfactorily used for visual rehabilitation after DALK in more recent reports 7,10–12…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up</p>

Malheiro¹,

Coelho²,

Neves³

et al. 2019

OPTH

View full text Add to dashboard Cite

PurposeTo report outcomes of phakic intraocular lens (IOL) implantation after deep anterior lamellar keratoplasty (DALK) to correct high ametropia.SettingCentro Hospitalar Universitário do Porto, Portugal.MethodsRetrospective case series with 11 eyes submitted to phakic IOL implantation after DALK. Main outcomes measured were uncorrected and corrected distance visual acuity (UDVA and CDVA), refractive error components, tomographic parameters and endothelial cell density (ECD). The minimum follow-up was 3 years for all cases.ResultsMean ECD loss was 8.7±6.7% at 1 year, 13.1±8.6% at 3 years (n=11; p=0.016, p=0.007, respectively) and 14.0±20.4% at 5 years (n=5, p=0.212). Mean logMAR UDVA increased from 1.27±0.90logMAR preoperatively to 0.16±0.15logMAR postoperatively (p≤0.001) and no statistically significant differences were registered during follow-up. All patients gained at least 5 lines of UDVA. 54.5% of the eyes gained 1 line in CDVA postoperative and only one eye lost one CDVA line through follow-up. Efficacy and safety indexes at 1 and 3 years were 1.01–0.97 and 1.24–1.21, respectively. Mean spherical equivalent was reduced from −7.84±4.63 D preoperatively to −1.05±1.07 D postoperatively (p=0.001). Mean percentage of reduction in refractive cylinder and spherical error was 83.8±15.8% and 73.1±31.5%, respectively, p≤0.001 for both. In one eye there was a significantly gradual ECD loss over 5 years follow-up and the patient will be submitted to IOL explant.ConclusionPhakic IOLs were effective for correction high ametropia after DALK, showing high efficacy and safety indexes with stability over time. However, it was registered a continuing endothelial cell loss postoperatively, which assumed to be higher than those reported in eyes without DALK.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up</p>

Malheiro¹,

Coelho²,

Neves³

et al. 2019

OPTH

View full text Add to dashboard Cite

show abstract

“…Moreover, since the corneal epithelium acts as a fluid masking agent, trans-epithelial ablation allows us to eliminate the variability of epithelial thickness due to remodeling and outcomes could be more consistent with the target. 11 , 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Topography-Guided Trans-Epithelial No-Touch Photorefractive Keratectomy for High Irregular Astigmatism After Penetrating Keratoplasty: A Prospective 12-Months Follow-Up

Spadea¹,

Visioli²,

Mastromarino³

et al. 2021

TCRM

View full text Add to dashboard Cite

Purpose To describe the efficacy and safety of topography-guided trans-epithelial no-touch photorefractive keratectomy (PRK) for the correction of highly irregular astigmatism after penetrating keratoplasty (PK). Patients and Methods A prospective study was conducted on 12 eyes of 12 patients affected by highly irregular astigmatism after PK for keratoconus. Each patient underwent a single-step topography-guided trans-epithelial ablation (CIPTA ® 2 software, iVis Technologies). Corneal topography data as well as uncorrected (UDVA) and corrected distance visual acuity (CDVA) and spherical equivalent (SEQ) were collected preoperatively (T0) and at 1 (T1), 3 (T2) and 12 (T3) months after surgery. Results Mean UDVA and CDVA significantly improved, respectively, from 1.22±0.17 and 0.18±0.03LogMAR at T0 to 0.63±0.17 (CI 95%, P<0.001) and 0.04±0.03LogMAR at T3 (CI 95%, P<0.001). Mean SEQ significantly decreased from −3.75±1.32 to –1.60±1.32D (CI 95%, P<0.02). Mean subjective refractive astigmatism (SRAST) and mean keratometry astigmatism (SimK) significantly decreased, respectively, from 7.83±0.98 and 8.10±1.48D to 2.83±0.98 and 5.29±1.48D (CI 95%, P<0.001). Corneal Morphological Irregularity index (CMI) significantly decreased from 62.76±7.26 µm to 23.24±7.26 µm (CI 95%, P<0.001). Apart from a single episode of graft rejection 5 days after ablation, successfully reverted with topical steroids, no other complications were noted. A mild corneal haze was observed in two eyes (16.7%) at 3 months post-PRK, and no regression was observed at 12 months. Conclusion Our study demonstrates the safety and long-term effectiveness of a trans-epithelial topography-guided ablation in the treatment of post-PK highly irregular astigmatism.

show abstract

“…Additionally, twelve months postoperatively the lines of vision increased, and astigmatism, corneal best-fit sphere, mean keratometry, corneal thickness, corneal total RMS, and corneal SA decreased. In another retrospective series by Sorkin et al, 9 34 eyes were treated with TG-PRK for post-PKP irregular astigmatism; this was followed by additional surface ablation in case of residual refractive error. In their study, mean CDVA also improved significantly: 1 line or more in 54.2%, and 3 lines or more in 16.7% of the analyzed eyes.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Most cases of irregular astigmatism are secondary to corneal causes, and TG treatments have been used in these cases with satisfactory results. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]20,21 When the aberrations exist at the level of the cornea, the information provided by the topographer is then transferred to a laser platform, which subsequently plans a treatment based on the specific irregularity and higher order aberrations of that specific cornea. The regularizing procedure itself may induce some refractive shift that will further need to be corrected.…”

Section: Introductionmentioning

confidence: 99%

Aberrometric, Keratometric, and Visual Outcomes After Trans-Epithelial Topography-Guided Phototherapeutic Keratectomy for the Treatment of Irregular Corneas

Cano-Ortiz¹,

Morales²,

Sánchez-Ventosa³

et al. 2021

OPTH

View full text Add to dashboard Cite

Purpose: To assess the safety, aberrometric and keratometric changes, and stability of transepithelial topography-guided phototherapeutic keratectomy (TE-TG-PTK) with mitomycin C (MMC) using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. Methods: This is a retrospective case series including 57 eyes that underwent TE-TG-PTK + MMC using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. CDVA, manifest refraction (MR), keratometry readings, and aberrometry readings were analyzed at 1, 3, 6, and 12 months. Results: Causes of corneal irregularity included non-infectious leucoma (n=23), infectious leucoma (n=7), adenoviral keratitis (n=20), corneal haze (n=2), post-penetrant keratoplasty (PKP) (n=1), and others (n=4). Overall, 76% of the eyes (n=40) gained lines of vision; patients gained 1, and 2 or more lines of vision in 76%, and 38% of cases, respectively. Only 1 patient (2%) lost 5 lines of vision. Mean preoperative CDVA (LogMAR) was 0.37 ±0.31 and improved to 0.14 ±0.18 (p<0.001) at final follow-up (12 months). CDVA remained unchanged in 10 eyes (21%). No significant changes were observed in mean keratometry (Kmean) and keratometric astigmatism readings. Regarding aberrometry, only changes in coma proved to be significant 6 months after surgery (P<0.01). No intraoperative/postoperative complications were reported. Conclusion: At final follow-up, significant improvements were observed in CDVA and coma. TE-TG-PTK + MMC proved to be an effective and safe procedure for the treatment of corneal irregular astigmatism due to several causes.

show abstract

Stepwise Guided Photorefractive Keratectomy in Treatment of Irregular Astigmatism After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Abstract: The stepwise topography-guided photorefractive keratectomy approach in cases of irregular astigmatism after PKP or DALK can help improve visual acuity outcomes. Patients should be appropriately counseled that more than 1 treatment will likely be needed.

Cited by 24 publications

References 17 publications

<p>Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up</p>

<p>Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up</p>

Topography-Guided Trans-Epithelial No-Touch Photorefractive Keratectomy for High Irregular Astigmatism After Penetrating Keratoplasty: A Prospective 12-Months Follow-Up

Aberrometric, Keratometric, and Visual Outcomes After Trans-Epithelial Topography-Guided Phototherapeutic Keratectomy for the Treatment of Irregular Corneas

Contact Info

Product

Resources

About