Peripheral ulcerative keratitis (PUK) is an inflammatory condition of the peripheral cornea with hallmark features of epithelial defects and stromal destruction as a result of a complex interplay of factors including host autoimmunity and... more
Peripheral ulcerative keratitis (PUK) is an inflammatory condition of the peripheral cornea with hallmark features of epithelial defects and stromal destruction as a result of a complex interplay of factors including host autoimmunity and the peculiar anatomic and physiologic features of the peripheral cornea and environmental factors. PUK may be the result of local or systemic causes and infectious or non-infectious causes. Arriving at a specific etiological diagnosis requires a meticulous clinical workup that may include a battery of laboratory and radiological investigations. Management by a team of internists or rheumatologists and ophthalmologists and judicious use of immunosuppressive agents may yield favorable results while minimizing adverse effects. We review current clinical knowledge on the diagnosis and management of PUK.
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Keratoconjonctivitis sicca, scleritis and keratitis remain the major ocular manifestation, associated with rheumatoid arthritis. Corneal ulcers are a rare complication but can lead to perforation. Unstable epithelial barrier and immune... more
Keratoconjonctivitis sicca, scleritis and keratitis remain the major ocular manifestation, associated with rheumatoid arthritis. Corneal ulcers are a rare complication but can lead to perforation. Unstable epithelial barrier and immune disorders play a key role in the pathophysiology of such corneal melting. Moreover the association with systemic vasculitis reveals the need for an appropriate immunosuppressive treatment. New surgical approaches and early immunotherapy allow to maintain ocular integrity even if the visual prognosis is poor.
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KBG syndrome, named after the initials of the first 3 families reported, is a rare genetic syndrome caused by a deletion or a mutation of ANKRD11 (ankyrin repeat domain-containing protein 11) gene. Its prevalence is probably... more
KBG syndrome, named after the initials of the first 3 families reported, is a rare genetic syndrome caused by a deletion or a mutation of ANKRD11 (ankyrin repeat domain-containing protein 11) gene. Its prevalence is probably underestimated because of a variable expressivity; moreover, most of its clinical characteristics are not specific. There is no consensus about its diagnostic criteria. Ophthalmologic manifestations have sometimes been described among more frequent clinical signs. Early detection is critical and multidisciplinary care is requested in order to ensure the patient's independence. We report the case of a 16 years old boy diagnosed with a KBG syndrome after more than one year of genetic research, motivated by a short stature, high refractive errors and bilateral corneal clouding.
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As the leading cause of blindness in the world, corneal diseases are second only to cataracts. However, the epidemiology of corneal disease is complex and includes a wide variety of infectious and inflammatory eye diseases (trachoma),... more
As the leading cause of blindness in the world, corneal diseases are second only to cataracts. However, the epidemiology of corneal disease is complex and includes a wide variety of infectious and inflammatory eye diseases (trachoma), immune sequelae (cicatricial pemphigoid on Lyell's disease) of after trauma (chemical burn). The general treatment for severe corneal disease is the corneal transplantation with penetrating keratoplasty. However, the failure of this treatment is virtually certain when the ocular surface is severely compromised. Keratoprosthesis is therefore the only viable option to restore vision in these patients. Only practiced by less than a dozen teams in the world, the osteo-odonto-keratoprosthesis (OOKP) is regularly practiced at the University Hospital of Liège, thanks to a close collaboration between the ophthalmology and maxillofacial surgery teams. Thanks to removal of a tooth and his bone support, patients suffering from bilateral dry eye following pathologies such as burns or cicatricial pemphigoid can benefit from this technique in order to recover an optimal visual acuity in a sustainable way.
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The author proposes an evaluation of studies concerning H.L.A.-typing in corneal graft. The importance of class-II antigens in corneal graft rejection is pointed out. A retrospective and prospective multicentric study should be started.
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Research Interests: Radiotherapy, Medicine, Humans, Molecular Immunology in Autoimmune Diseases, Autoimmune diseases, and 14 moreFemale, Pubmed, Male, Hyperthyroidism, Aged, Middle Aged, Plasmapheresis, Gynecology, Adult, Graves Disease, Methylprednisolone/therapeutic Use, Orbit, Combined Modality Therapy, and Methylprednisolone
As a common reason for consultation, red eye can be a symptom of benign diseases, such as conjunctivitis, subconjunctival hemorrhage, dry eye syndrome,..., which can be managed by the general practitioner or internist. Conversely, more... more
As a common reason for consultation, red eye can be a symptom of benign diseases, such as conjunctivitis, subconjunctival hemorrhage, dry eye syndrome,..., which can be managed by the general practitioner or internist. Conversely, more serious pathologies require a ophthalmologist management: these are keratitis, uveitis, acute glaucoma attack, or endophtalmitis. This article is intended to help practitioner to guide diagnosis when he's faced with a red eye.
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Anterior stromal puncture has been proposed as a new treatment for recurrent corneal erosion. A soft technique with a curved needle minimize scarring and prevent corneal perforation. An insertion depth of 0.1 mm was sufficient to cause... more
Anterior stromal puncture has been proposed as a new treatment for recurrent corneal erosion. A soft technique with a curved needle minimize scarring and prevent corneal perforation. An insertion depth of 0.1 mm was sufficient to cause the production of new basement membrane attached to the anterior stroma. GEGGEL and coll. use a new technique with multiple applications of the Nd Yag Laser on the basement membrane. The laser punctures would be more reproducible and work as well as stromal punctures.
Research Interests: Medicine, Humans, Basement Membrane, Pubmed, Recurrence, and 3 morePerforation, Laser Therapy, and stroma
Ocular chemical or physical burns currently represent 12 % of domestic accidents in Europe. They can lead to numerous ophthalmologic sequelae ranging from simple superficial keratitis to conjunctival ischemia and the destruction of limbal... more
Ocular chemical or physical burns currently represent 12 % of domestic accidents in Europe. They can lead to numerous ophthalmologic sequelae ranging from simple superficial keratitis to conjunctival ischemia and the destruction of limbal corneal stem cells. This results in damages to the cornea which can progress to neovascularization and corneal invasion by conjunctival tissue. Long term consequences affect ocular function (sometimes blindness, stromal degradation, infections, or even ocular perforation). Until now, few treatments were available to restore corneal transparency after a trauma. Patients affected by post-traumatic limbal stem cell deficiency unfortunately had little prospect. Regenerative cell therapy, of which Holoclar® is a part, could revolutionize the future of these patients.
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The authors present a clinical case of a young woman presenting a non typical melanoma with optic disc oedema. The results of the different examinations are presented and the importance of an N.M.R. is stressed. The differential diagnosis... more
The authors present a clinical case of a young woman presenting a non typical melanoma with optic disc oedema. The results of the different examinations are presented and the importance of an N.M.R. is stressed. The differential diagnosis is discussed.
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Corneal transplantation or keratoplasty has rapidly developed over the last 10 years. Penetrating keratoplasty, a well-known operation consisting of full thickness replacement of the cornea, has remained the dominant procedure for a long... more
Corneal transplantation or keratoplasty has rapidly developed over the last 10 years. Penetrating keratoplasty, a well-known operation consisting of full thickness replacement of the cornea, has remained the dominant procedure for a long time. It allows appropriate therapy of most causes of corneal blindness. However, this technique is currently evolving toward slamellar keratoplasties which selectively treat the specific affected layers: deep anterior lamellar keratoplasty replaces the diseased corneal stromal layers; endothelial keratoplasty replace the affected endothelium. This article will present these techniques, and briefly discuss their advantages.
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The aim of this human research protocol is to determine the efficacy of using preserved human amniotic membrane for reconstruction surgery for ocular surface. Case report and literature will be presented. The characteristics of a new... more
The aim of this human research protocol is to determine the efficacy of using preserved human amniotic membrane for reconstruction surgery for ocular surface. Case report and literature will be presented. The characteristics of a new surgical approach using human amniotic membrane will be described.
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Conjunctival stitches might be tricky on a thin conjunctival graft. They are often responsible for ocular inflammation. The use of fibrin glue permits a conjunctival surgery without stitches. It is a real improvement in pterygium surgery.... more
Conjunctival stitches might be tricky on a thin conjunctival graft. They are often responsible for ocular inflammation. The use of fibrin glue permits a conjunctival surgery without stitches. It is a real improvement in pterygium surgery. It helps the surgeon and improves the patient comfort
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Limbal graft harvesting might sometimes not be possible in pterygium surgery (previous surgeries, burns, conjunctival pathology, filtering bleb...). The use of an amniotic membrane might be an alternative to a thicker labial mucosa graft.... more
Limbal graft harvesting might sometimes not be possible in pterygium surgery (previous surgeries, burns, conjunctival pathology, filtering bleb...). The use of an amniotic membrane might be an alternative to a thicker labial mucosa graft. Fibrin glue, as in conjunctival grafting, permits a surgery without stitches which is a help to the surgeon and a relief to the patient
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Panophtalmitis is an intra-ocular and intra-orbital rare infection, but its consequences are often horrendous, with loss of both function and anatomy of the eye. The surgical approach and the antibiotherapy should be given as soon as... more
Panophtalmitis is an intra-ocular and intra-orbital rare infection, but its consequences are often horrendous, with loss of both function and anatomy of the eye. The surgical approach and the antibiotherapy should be given as soon as possible, both by intra-vitreal and intra-venous injections. We report the case of a 49-year-old man who developed a Bacillus cereus panophtalmitis. A delay in the diagnosis lead to the loss of vision and the evisceration of the sick eye. Bacillus cereus panopthalmitis should be suspected in all cases of post-traumatic endophtalmitis with a soiled metallic foreign body, in patients with important local inflammatory signs as well as systemic signs. Vitrectomy, surgical extraction of the foreign body, intra-vitreal and systemic antibiotherapies should be given as soon as possible, even before the results of the bacteriological analysis
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The treatment of the central retinal vein occlusion (CRVO) is a debated question. Isovolaemic haemodilution known for its beneficial effects on the tissue microcirculation has shown encouraging results. A first study on 14 patients seems... more
The treatment of the central retinal vein occlusion (CRVO) is a debated question. Isovolaemic haemodilution known for its beneficial effects on the tissue microcirculation has shown encouraging results. A first study on 14 patients seems to indicate beneficial effects of isovolaemic haemodilution versus spontaneous evolution.
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Ocular chemical or physical burns currently represent 12 % of domestic accidents in Europe. They can lead to numerous ophthalmologic sequelae ranging from simple superficial keratitis to conjunctival ischemia and the destruction of limbal... more
Ocular chemical or physical burns currently represent 12 % of domestic accidents in Europe. They can lead to numerous ophthalmologic sequelae ranging from simple superficial keratitis to conjunctival ischemia and the destruction of limbal corneal stem cells. This results in damages to the cornea which can progress to neovascularization and corneal invasion by conjunctival tissue. Long term consequences affect ocular function (sometimes blindness, stromal degradation, infections, or even ocular perforation). Until now, few treatments were available to restore corneal transparency after a trauma. Patients affected by post-traumatic limbal stem cell deficiency unfortunately had little prospect. Regenerative cell therapy, of which Holoclar® is a part, could revolutionize the future of these patients.
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Research Interests: Humanities and ROUGE
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ABSTRACT Purpose: To evaluate the effect of increased intraocular pressure (IOP) on the corneal shape of human cadaver eyes. Methods: Eight cadaver eyes, unsuitable for transplantation donated by the Florida Lions Eye Bank, were assessed... more
ABSTRACT Purpose: To evaluate the effect of increased intraocular pressure (IOP) on the corneal shape of human cadaver eyes. Methods: Eight cadaver eyes, unsuitable for transplantation donated by the Florida Lions Eye Bank, were assessed for overall integrity. The epithelium was debrided, the eye placed into an artificial orbit, and a 30-gauge needle (connected to the IOP monitor) was inserted into the vitreous cavity. The IOP was altered as necessary by adjusting the height of the lactated ringers IV bottle. The surface contour was assessed at pressure levels: hypotony (2-4 mmHG), normal physiologic IOP (12-20 mmHg), hypertony (135-142 mmHg) and again at normal and low IOP. At each pressure level, two corneal topographic measurements (PAR CTSTM Vision Systems Corp.) were captured and averaged. Keratometric analysis was completed to examine the dioptric effects of varying IOP. An elevation analysis was performed to determine the corneal locations which conformed to the pressure adjustments. Results: The keratometric and elevation (both 0 and 90 degree meridians) data revealed decreasing radii with increasing IOP however, variability precluded statistical significance. Both keratometric and elevation data displayed probable plastic deformation, as the radii deviated from the original measurement upon the return to 2-4 mmHg. The elevation analysis did suggest an astigmatic conformation to pressure fluctuations, as 90 degree meridian radii were greater than 0 degree meridian radii. Corneal deformation is minimal in the 2 to 140 mmHg range and the PAR system not sensitive enough to accurately determine changes in curvature. Conclusion: The cornea does not uniformly conform to IOP variation. Further investigations with IOP levels of up to 500 mmHg will provide more information with respect to changes in curvature as a function of IOP.
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Purpose. Experimentally find a method to provide a safe surgical technique and an inexpensive and long lasting mesoplant for the restoration of vision in patients with bilateral corneal blindness due to ocular surface and stromal... more
Purpose. Experimentally find a method to provide a safe surgical technique and an inexpensive and long lasting mesoplant for the restoration of vision in patients with bilateral corneal blindness due to ocular surface and stromal diseases. Methods. Identify the least invasive and the safest surgical technique for synthetic cornea implantation. Identify the most compatible biomaterials and the optimal shape a synthetic cornea must have to last a long time when implanted in vivo. Results. Penetrating procedures were deemed too invasive, time consuming, difficult and prone to long term complications. Therefore a non-penetrating delamination technique with central trephination was developed to preserve the integrity of Descemet's membrane and the anterior segment. Even though this approach limits the number of indications, it is acceptable since the majority of patients only have opacities in the stroma. The prosthesis was designed to fit in the removed tissue plane with its skirt fitted under the delaminated stroma. To improve retention, the trephination wall was made conical with the smallest opening on the anterior surface and a hat-shaped mesoplant was made to fit. The skirt was perforated in its perimeter to allow passage of nutrients and tissues ingrowths. To simplify the fabrication procedure, the haptic and optic were made of the same polymer. The intrastromal biocompatibility of several hydrogels was found superior to current clinically used PMMA and PTFE materials. Monobloc mesoplants made of 4 different materials were implanted in rabbits and followed weekly until extrusion occurred. Some remained optically clear allowing for fundus photography. Conclusions. Hydrogel synthetic corneas can be made to survive for periods longer than 1 year. ArF excimer laser photoablation studies are needed to determine the refractive correction potential of these mesoplants. A pilot FDA clinical trial is needed to assess the mesoplant efficacy and very long-term stability.
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To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were... more
To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195-325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high. eal
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We report on a child with a generalized skin disorder associated with other minor anomalies. At birth, the child presented as a collodion baby, with patchy erythema, generalized irregular dermal atrophy, alopecia, absent eyelashes and... more
We report on a child with a generalized skin disorder associated with other minor anomalies. At birth, the child presented as a collodion baby, with patchy erythema, generalized irregular dermal atrophy, alopecia, absent eyelashes and eyebrows, and conjunctival pannus. He also had hypertelorism, prominent nasal root, large mouth, micrognathia, brachydactyly, syndactyly involving all interdigital spaces, and camptodactyly of fingers III-V. The hyperkeratotic membrane thinned progressively, leaving a mottled reticulated skin atrophy, with patchy areas of yellowish hyperpigmentation and papyraceous areas. Hair and nails were dystrophic. Mental development was borderline normal. The histological hallmarks of the skin manifestations combined orthokeratotic hyperkeratosis and marked atrophy of the dermis. The dermal extracellular matrix was immature, and factor XIII-a positive dendrocytes were rare and globular rather than dendritic. We frame as a hypothesis that the disease is due to or associated with a defect in maturation of a subset of dermal dendrocytes during fetal life. This entity may be designed as the koraxitrachitic syndrome (kappaomicronrhoalphaxi:grapnel- taurhoalphachiiotatauepsilonsigma: roughness)
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Research Interests: Iconography and Art
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Peripheral ulcerative keratitis (PUK) is a disorder of the juxtalimbal cornea characterised by a crescent-shape destructive inflammation of corneal stroma. PUK can be associated with various ocular and systemic infectious and non... more
Peripheral ulcerative keratitis (PUK) is a disorder of the juxtalimbal cornea characterised by a crescent-shape destructive inflammation of corneal stroma. PUK can be associated with various ocular and systemic infectious and non infectious diseases. Different systemic autoimmune vasculitis that can prove potentially fatal may present as PUK. Potentially serious ocular complications of PUK exist. A careful clinical evaluation helps in timely diagnosis and prevention of complications.
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Merkel cell carcinoma is a neuroendocrine tumor of the skin, originating from neuroendocrine cells. A case report of Merkel cell carcinoma, discovered in a 77-year-old woman, was diagnosed an confirmed on a biopsy. Diagnostic and... more
Merkel cell carcinoma is a neuroendocrine tumor of the skin, originating from neuroendocrine cells. A case report of Merkel cell carcinoma, discovered in a 77-year-old woman, was diagnosed an confirmed on a biopsy. Diagnostic and therapeutic orientations of this unusual but malignant tumor are described.Peer reviewe
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L'osteo-odonto-keratoprothese est une procedure chirurgicale complexe cherchant à restaurer la vision dans des situations de cécité d'origine cornéenne habituellement irrémédiables telles que brûlures chimiques, syndromes de Lyell... more
L'osteo-odonto-keratoprothese est une procedure chirurgicale complexe cherchant à restaurer la vision dans des situations de cécité d'origine cornéenne habituellement irrémédiables telles que brûlures chimiques, syndromes de Lyell et de Stevens-johnson, pemphigoïdes, trachome, multiples rejets de greffes cornéennes... Elle consiste en 2 ou 3 étapes longues et fastidieuses nécessaires à implanter au travers de la cornée opaque, une optique incluse dans une dent (dent dans l'oeil). La dent est prélevée dans sa totalité, avec son ligament et son os alvéolaire. Une lamine tissulaire est ensuite affinée et perforée afin de permettre le passage d'une optique en PMMA. La lamine ainsi préparée est mise en nourrice dans la joue pour plusieurs mois, pour être enfin implantée sur l'oeil, recouverte d'une greffe de muqueuse nourricière et protectrice. Cette fabuleuse technique chirurgicale a été imaginée par le Professeur Strampelli au début des années 60. Le Professeur ...
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Panophtalmitis is an intra-ocular and intra-orbital rare infection, but its consequences are often horrendous, with loss of both function and anatomy of the eye. The surgical approach and the antibiotherapy should be given as soon as... more
Panophtalmitis is an intra-ocular and intra-orbital rare infection, but its consequences are often horrendous, with loss of both function and anatomy of the eye. The surgical approach and the antibiotherapy should be given as soon as possible, both by intra-vitreal and intra-venous injections. We report the case of a 49-year-old man who developed a Bacillus cereus panophtalmitis. A delay in the diagnosis lead to the loss of vision and the evisceration of the sick eye. Bacillus cereus panopthalmitis should be suspected in all cases of post-traumatic endophtalmitis with a soiled metallic foreign body, in patients with important local inflammatory signs as well as systemic signs. Vitrectomy, surgical extraction of the foreign body, intra-vitreal and systemic antibiotherapies should be given as soon as possible, even before the results of the bacteriological analysis
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L'ophtalmopathie thyroidienne est une pathologie orbitaire qui touche principalement la femme entre 30 et 50 ans; elle est souvent accompagnee d'une hyperthyroidie mais elle peut preceder ou suivre celle-ci. L'origine... more
L'ophtalmopathie thyroidienne est une pathologie orbitaire qui touche principalement la femme entre 30 et 50 ans; elle est souvent accompagnee d'une hyperthyroidie mais elle peut preceder ou suivre celle-ci. L'origine auto-immune de cette affection est reconnue et en conditionne le traitement. L'ophtalmopathie etant souvent stabilisee a terme, nous essayons d'eviter des therapeutiques trop agressives. Le premier traitement reste l'equilibration de l'hyperthyroidie et plus d'un tiers des patients ne necessitent pas d'autre traitement oculaire; lorsque celui-ci est necessaire, nous preferons l'utilisation de corticoides iv en mega-doses en premiere intention. Cette therapeutique est completee par une radiotherapie orbitaire quand cela s'avere necessaire. Nous n'aborderons pas dans cet article le traitement chirurgical de l'ophtalmopathie thyroidienne.
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Corneal transplantation or keratoplasty has rapidly developed over the last 10 years. Penetrating keratoplasty, a well-known operation consisting of full thickness replacement of the cornea, has remained the dominant procedure for a long... more
Corneal transplantation or keratoplasty has rapidly developed over the last 10 years. Penetrating keratoplasty, a well-known operation consisting of full thickness replacement of the cornea, has remained the dominant procedure for a long time. It allows appropriate therapy of most causes of corneal blindness. However, this technique is currently evolving toward slamellar keratoplasties which selectively treat the specific affected layers: deep anterior lamellar keratoplasty replaces the diseased corneal stromal layers; endothelial keratoplasty replace the affected endothelium. This article will present these techniques, and briefly discuss their advantages.
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To assess the efficacy of a control drug release implant coated with 5-Fu placed in the capsular bag for the prevention of the secondary cataract.
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Purpose. Experimentally find a method to provide a safe surgical technique and an inexpensive and long lasting mesoplant for the restoration of vision in patients with bilateral corneal blindness due to ocular surface and stromal... more
Purpose. Experimentally find a method to provide a safe surgical technique and an inexpensive and long lasting mesoplant for the restoration of vision in patients with bilateral corneal blindness due to ocular surface and stromal diseases. Methods. Identify the least ...
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ABSTRACT Purpose: To assess keratometric changes of a new surgical refractive technique (Gel Injection Adjustable Keratoplasty or GIAK) on Eye Bank eyes. Conceived by G. Simon in 1989, GIAK consists of making a flat 360 degree... more
ABSTRACT Purpose: To assess keratometric changes of a new surgical refractive technique (Gel Injection Adjustable Keratoplasty or GIAK) on Eye Bank eyes. Conceived by G. Simon in 1989, GIAK consists of making a flat 360 degree intrastromal annular delamination track centered around the corneal apex and filling it with a soft gel. Methods: The track, which was made with customized helicoidal delaminators, was delaminated parallel to the corneal surface at 80% depth and was filled with a biocompatible crosslinked polyethylene oxide gel. The procedure was preformed on fresh cadaver eyes using 10 delaminators with different inner diameters (4.5, 5.0, 5.5, 6.0, 6.5, 7.0 mm) and widths (1.00 and 1.25 mm). The annular track was filled to capacity. Keratometric changes were evaluated with an automated surgical keratometer. Results: The keratometric changes induced by GIAK were between 3.4 and 11.9 diopters on average. Conclusions: This surgical technique effectively flattens the cornea and promises to be an effective technique for correction of myopia.