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Modified big-bubble deep anterior lamellar keratoplasty using peripheral air injection.

PURPOSE: To introduce a modification to big-bubble deep anterior lamellar keratoplasty (DALK) which can decrease the risk of Descemet membrane (DM) perforation during air injection. METHOD: In Anwar's big-bubble technique, a 27-guage needle is inserted from the trephination site and advanced into the corneal stroma up to the centre. The technique we introduce modifies the original technique in the following fashion. After trephination to approximately 80% of corneal thickness, a 27-guage needle is inserted into the stroma peripherally from the trephination site towards the limbus. Air is inje

Graft failure in human donor corneas due to transmission of herpes simplex virus.

AIM: To report the clinical consequences of contamination of human donor corneas by herpes simplex virus (HSV) in organ culture. METHODS: Two patients without previous history of ocular HSV infection underwent penetrating keratoplasty (PK), one for keratoconus and the other for Fuchs' endothelial dystrophy. One patient suffered primary graft failure while the other developed a persistent epithelial defect, ultimately resulting in graft failure. Viral culture of swabs taken from both corneas during the early postoperative period was undertaken. The failed donor corneas were examined histopatho…

Contributions of electron microscopy to the study of corneal pathology.

Most of the electron microscopic studies of pathological corneas have been done only recently. Keratoplasty has been the most important source of specimens for ultramicroscopic investigation. With the introduction of electron microscopic techniques, we have been able to confirm many light microscopic studies in pathological corneas. This contribution has been most valuable in the identification of the sites and types of pathological changes in corneal dystrophies and degenerations. This review of electron microscopic studies describes the present concepts on the nature of the histological chan

Visual and ocular surface benefits of mini-scleral contact lenses in patients with chronic ocular graft-versus-host disease (GvHD).

Graft-versus-Host disease is a major complication of allogeneic stem cell transplantation. The eyes are a frequently affected organ with a severe dry eye disease being the hallmark manifestation. This retrospective study evaluates the effect of mini-scleral contact lenses on visual acuity, eye-related quality of life and the ocular surface. 62 eyes of 31 patients were included and visual acuity, ocular surface disease index (OSDI) questionnaire results and Oxford grades before and after mini-scleral lens fitting were compared. Median Snellen fraction with mini-scleral lenses was 20/25 (1st 20/

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… To date, most studies investigating mini-scleral lenses focused on visual rehabilitation in keratoconus and there are no comprehensive studies on their use in ocular GvHD. … Two major indications are higher refractive errors, e.g. in keratoconus or after keratoplasty, and severe ocular surface disease 9 . …

Comparison of two different 360-degree intrastromal corneal rings combined with simultaneous accelerated-corneal cross-linking.

PURPOSE: to compare five-year outcomes of two complete intracorneal implants (MyoRing versus annular-shaped intracorneal implant [AICI]) combined with accelerated corneal cross-linking (A-CXL) in progressive KCN. METHODS: In this historical cohort study, preoperative and postoperative visual, refractive, tomographic, biomechanical, and aberrometric parameters of 27 eyes of 27 patients who underwent implantation of two complete rings (13 AICI and 14 MyoRing) combined with A-CXL were recorded. RESULTS: The mean age of patients in "AICI plus A-CXL" and "MyoRing plus A-CXL" groups were 28.1 ± 4.

Effect of Time on Scleral Lens Settling and Change in Corneal Clearance.

SIGNIFICANCE: With the increase in the use of scleral contact lenses among practitioners, questions regarding lens settling are gradually ga … epths. METHODS: Three scleral contact lenses were fitted to 20 subjects with previous diagnosis of keratoconus (n = 18) or pellucid marginal degeneration (n = 2). The fit was based on corneal sagittal height measured with the Visante optical coherence tomographer (OCT) at 15 mm along the horizontal meridian. To select an appropriate lens from the diagnostic …

Comparison of In Vivo Confocal Microscopy, Ultrasonic Pachymetry, and Scheimpflug Topography for Measuring Central Corneal Thickness.

IMPORTANCE: In vivo confocal microscopy could be useful in cases of fungal or acanthamoeba keratitis to determine the depth of infectious elements, but its accuracy in determining corneal thickness relative to more traditional techniques has not been well characterized. OBSERVATIONS: In this cross-sectional observational case series, central corneal thickness was determined by in vivo confocal microscopy, ultrasonic pachymetry, and Scheimpflug topography in 47 normal corneas and 23 keratoconic corneas from November 2014 to July 2015. Analyses undertaken from July 2015 to August 2015 showed th

The therapeutic and optical application of a rigid gas permeable semi-limbal diameter contact lens.

PURPOSE: To evaluate the therapeutic and optical application of a semi-limbal diameter (S-LIM) rigid gas permeable (RGP) contact lens. METHOD: A retrospective non-comparative case series of 14 consecutive patients (22 eyes) who were referred to one senior optometrist for the fitting of S-LIM contact lenses at Moorfields Eye Hospital. The cases comprised of 11 patients (17 eyes) with keratoconus, 1 patient (2 eyes) post-surgical ectasia from previous LASIK, 1 (1 eye) post-graft patient, and 1 patient (2 eyes) who required corneal protection secondary to lagophthalmos. These patients had failed…

Safety and efficacy of contact lens-assisted accelerated corneal cross-linking using Nelfilcon A in thin corneas.

PURPOSE: To evaluate the efficacy and safety of contact lens-assisted accelerated corneal cross-linking (A-CACXL) using a UV-filter-free nelfilcon A daily hydrogel lens in thin corneas (≤ 400 µm). METHODS: Retrospective single-center series of 28 eyes (23 patients) with progressive keratoconus and post-debridement pachymetry ≤ 400 µm; minimum follow-up 6 months. A-CACXL employed a 100-µm nelfilcon A lens. Outcomes at Baseline, Month 1, Month 3, and Month 6 included UCVA/BCVA (logMAR), refraction, K1, K2, Kmean, Kmax (D), minimum corneal thickness (MCT, µm), and endothelial cell count (ECC, ce…

Effect of Accelerated Epi-Off Crosslinking on Optical Quality, Corneal Aberrations, and Epithelial Wavefront During Adolescence.

OBJECTIVES: To examine the effect of accelerated epi-off crosslinking (A-CXL) on visual acuity and quality in adolescent patients with progressive keratoconus. MATERIALS AND METHODS: The study included 109 eyes of 109 patients (mean age 16.24±2.55 years). MS-39 anterior segment optical coherence tomography images from before A-CXL and 1 month, 6 months, and 12 months after A-CXL were analyzed. Corneal tomographic parameters, total corneal aberrations, corneal epithelial aberrations, and optical quality indicators such as modulation transfer function (MTF) and Strehl ratio of the point spread …

Biological assessment and preservation strategies for SMILE- derived lenticules: towards a corneal regenerative biobank.

Human stromal corneal lenticules (hSCLs) extracted during keratorefractive lenticule extraction (KLEx) refractive surgery, including Small incision lenticule extraction (SMILE) procedure, are often discarded as medical waste, despite their potential for reimplantation in various ocular therapeutic applications. These include corneal thickness restoration in keratoconus, scleral patch grafts, and other ophthalmic procedures. Ensuring the safety and structural integrity of these lenticules for clinical use depends on proper preservation; however, a consensus on the most effective preservation me…

Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers.

PURPOSE: To evaluate the impact of high oxygen concentration using a novel oxygen chamber on epi-off corneal cross-linking (CXL) efficacy and patients' perceived pain during the procedure. SETTING: Farabi Eye Hospital, Tehran, Iran. DESIGN: Interventional randomized clinical trial. METHODS: Forty-eight eyes with progressive keratoconus were enrolled. The high-oxygen group (24 eyes) underwent accelerated epi-off CXL (9 mW/cm 2 UV-A, 5.4 J/cm 2 for 10 minutes) in a controlled high-oxygen environment (∼60%) using a novel oxygen chamber, while the control group (24 eyes) underwent the same prot…

Comparison of a Scheimpflug Camera and Optical Coherence Tomography in Evaluating Keratoconic Eyes Post Keratoplasty.

Background/Objective: The aim of this retrospective study was to compare corneal parameters and compliance using a Pentacam HR-Scheimpflug (Pentacam HR) and a swept-source OCT Casia (Casia) in keratoconus (KC) patients post penetrating keratoplasty (PKP) and KC patients without PKP, as well as a control group. Pachymetry measurements were also analyzed using a spectral domain OCT Solix (OCT Solix), Pentacam HR, and Casia. Methods: The study included 71 patients (136 keratoconic eyes; group A), 86 eyes with KC post-PKP (group B), 50 eyes with KC without PKP (group C), and 52 control participant…