Purpose: To compare the clinical outcomes of repeat penetrating keratoplasty (PK), Descemet strip... more Purpose: To compare the clinical outcomes of repeat penetrating keratoplasty (PK), Descemet stripping automated endothelial keratoplasty (‘DSAEK-on-PK’) or Descemet membrane endothelial keratoplasty (‘DMEK-on-PK’) for the management of endothelial failure of previous penetrating keratoplastyDesign: Retrospective, interventional consecutive case series. Participants: 104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020Intervention: Repeat keratoplastyMain Outcome Measures: Primary failure rate, 12 and 24 month survival, visual acuity at 12 and 24 months, rebubbling rate and complication profile.Results: Repeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). 6.6% of repeat PKs failed in the first 12 months compared to 19% of DSAEK and 36.4% of DMEK. Chances of ...
2009 by All rights Abstract. Mitomycin C has played a deciding role in the current revival of exc... more 2009 by All rights Abstract. Mitomycin C has played a deciding role in the current revival of excimer laser surface ablation techniques. We review the literature regarding mechanism of action of mitomycin C, histological effects on the cornea, and indications, dose, exposure time, and toxicity of mitomycin C in corneal refractive surgery. Mitomycin C is an alkylating agent with cytotoxic and antiproliferative effects that reduces the myofibroblast repopulation after laser surface ablation and, therefore, reduces the risk of postoperative corneal haze. It is used prophylactically to avoid haze after primary surface ablation and therapeutically to treat pre-existing haze. There is no definite evidence that establishes an exact diopter limit or ablation depth at which to apply prophylactic mitomycin C. It is usually applied at a concentration of 0.2 mg/ml (0.02%) for 12 to 120 seconds over the ablated stroma, although some studies suggest that lower concentrations (0.01%, 0.002%) could...
W hen refractive surgeons began to understand ocular aberrations, and laser platforms that could ... more W hen refractive surgeons began to understand ocular aberrations, and laser platforms that could perform complex treatments became available, the ability to perform customized treatments that would target ocular aberrations became an exciting possibility. First, with the treatment of postoperative aberrations, we hoped that the visual symptoms that were a nightmare for patients and surgeons alike would soon become a thing of the past. Second—and potentially more exciting—we wondered if these protocols could even improve the quality of vision of an eye that was receiving treatment for the first time. Over the past few years, results have shown that customized treatments are not the panacea we had hoped they would be, but they have been useful in specific conditions, especially when aberrations are high and symptomatic. Additionally, the ability to take into account induced aberrations in refractive surgery has led to a general improvement of laser profiles, even for noncustomized tre...
PURPOSE: To describe corneal and ocular surface abnormalities in patients with congenital aniridi... more PURPOSE: To describe corneal and ocular surface abnormalities in patients with congenital aniridia. METHODS: We examined 50 eyes in 25 patients with congenital aniridia. Schirmer’s test I and II, tear film break-up time, vital staining, tear ferning pattern test and impression cytology, Cochet-Bonnet aesthesiometry, specular microscopy and ultrasonic pachymetry were carried out. RESULTS: Based on Mackman’s classification, we found grade 0 in 12%, grade 1A in 52%, grade 1B in 20%, and grade 2 in 16% cases. Age, history of ocular surgery, dry eye score and aesthesiometry correlated with the degree of aniridia-related keratopathy (ARK). Schirmer’s test I was normal in 86.8%, Schirmer’s test II in 94.4% of the eyes and TFBUT in 83.3% of the cases. Corneal staining was altered in 54.2%, and conjunctival staining was altered in 45.7%. The tear ferning pattern was abnormal in 80%. Conjunctival metaplasia was present in 76.9%, and the presence of conjunctival goblet cells on the cornea corr...
To evaluate two silicone hydrogel contact lens materials as continuous-wear bandage contact lense... more To evaluate two silicone hydrogel contact lens materials as continuous-wear bandage contact lenses after laser-assisted subepithelial keratomileusis (LASEK). The inclusion criteria were myopia of -6.00 diopters (D) or less, astigmatism lower than -1.5 D, bilateral best-corrected visual acuity of 20/20 or better, and candidates for bilateral LASEK. The patients were randomized to be fitted with a Balafilcon A (PureVision) lens in one eye and Galyfilcon A (Acuvue Advance) in the fellow eye. Uncorrected visual acuity, corneal epithelial status, conjunctival and limbal hyperemia, lens movement, contact lens debris, and the responses to a subjective-comfort questionnaire were assessed postoperatively. The parameters were evaluated before and 1 and 5 days after the procedure. A paired Student's t-test and chi-square tests were used when appropriate. We analyzed 44 eyes of 22 consecutive patients who underwent LASEK to correct low-to-moderate myopia. The mean spherical equivalent was -3.25 +/- 2.36 D. There was no difference in conjunctival or limbal hyperemia, lens movement, uncorrected visual acuity, or epithelial healing between the two lenses at any visit. A significant difference was found in lens deposition and discomfort, which were greater with the PureVision lens 5 days postoperatively (p = 0.01 for both comparisons). PureVision and Acuvue Advance contact lenses seem to be useful as continuous wear bandage contact lenses. There is no major clinical difference between the lenses, although patients report greater comfort with Acuvue Advance.
To study the effect of the learning curve of laser-assisted subepithelial keratectomy (LASEK) on ... more To study the effect of the learning curve of laser-assisted subepithelial keratectomy (LASEK) on the visual and refractive results. This retrospective study comprised 56 eyes that had LASEK for myopia. The eyes were among the first 143 that had LASEK by the same surgeon with the same excimer laser and same nomogram. The 56 eyes were separated into 2 groups. Group 1 included the first 28 eyes to have LASEK by the surgeon. Group 2 comprised the last 28 eyes in the series whose refractive error could be matched with that in Group 1. The outcomes in the 2 groups were compared. The mean preoperative spherical refraction was -3.90 diopters (D) +/- 1.90 (SD) in Group 1 and -3.70 +/- 2.53 D in Group 2 (P = .2). There were no significant differences in preoperative cylinder or best spectacle-corrected visual acuity (BSCVA) between groups. The postoperative uncorrected visual acuity (UCVA) was significantly worse in Group 1 on 1 day and 7 days postoperatively (P = .02 and P = .03, respectively); there was no significant difference at 1 month and 3 months. The safety index (postoperative BSCVA/preoperative BSCVA) and efficacy index (postoperative UCVA/preoperative BSCVA) were better in Group 2, although the difference was not statistically significant. The spherical refraction 3 months postoperatively was +0.50 +/- 0.83 D in Group 1 and +0.10 +/- 0.27 D in Group 2 (P = .02); 75.00% of eyes and 96.42% of eyes, respectively, were within +/-0.50 D of the intended correction (P = .01). Seven percent of eyes in Group 1 and no eye in Group 2 lost 2 or more lines of BSCVA. Results indicate that the outcomes of LASEK depend on surgeon experience. Thus, caution is advised when interpreting LASEK results without knowing the surgeon's level of experience.
Purpose: To compare the clinical outcomes of repeat penetrating keratoplasty (PK), Descemet strip... more Purpose: To compare the clinical outcomes of repeat penetrating keratoplasty (PK), Descemet stripping automated endothelial keratoplasty (‘DSAEK-on-PK’) or Descemet membrane endothelial keratoplasty (‘DMEK-on-PK’) for the management of endothelial failure of previous penetrating keratoplastyDesign: Retrospective, interventional consecutive case series. Participants: 104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020Intervention: Repeat keratoplastyMain Outcome Measures: Primary failure rate, 12 and 24 month survival, visual acuity at 12 and 24 months, rebubbling rate and complication profile.Results: Repeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). 6.6% of repeat PKs failed in the first 12 months compared to 19% of DSAEK and 36.4% of DMEK. Chances of ...
2009 by All rights Abstract. Mitomycin C has played a deciding role in the current revival of exc... more 2009 by All rights Abstract. Mitomycin C has played a deciding role in the current revival of excimer laser surface ablation techniques. We review the literature regarding mechanism of action of mitomycin C, histological effects on the cornea, and indications, dose, exposure time, and toxicity of mitomycin C in corneal refractive surgery. Mitomycin C is an alkylating agent with cytotoxic and antiproliferative effects that reduces the myofibroblast repopulation after laser surface ablation and, therefore, reduces the risk of postoperative corneal haze. It is used prophylactically to avoid haze after primary surface ablation and therapeutically to treat pre-existing haze. There is no definite evidence that establishes an exact diopter limit or ablation depth at which to apply prophylactic mitomycin C. It is usually applied at a concentration of 0.2 mg/ml (0.02%) for 12 to 120 seconds over the ablated stroma, although some studies suggest that lower concentrations (0.01%, 0.002%) could...
W hen refractive surgeons began to understand ocular aberrations, and laser platforms that could ... more W hen refractive surgeons began to understand ocular aberrations, and laser platforms that could perform complex treatments became available, the ability to perform customized treatments that would target ocular aberrations became an exciting possibility. First, with the treatment of postoperative aberrations, we hoped that the visual symptoms that were a nightmare for patients and surgeons alike would soon become a thing of the past. Second—and potentially more exciting—we wondered if these protocols could even improve the quality of vision of an eye that was receiving treatment for the first time. Over the past few years, results have shown that customized treatments are not the panacea we had hoped they would be, but they have been useful in specific conditions, especially when aberrations are high and symptomatic. Additionally, the ability to take into account induced aberrations in refractive surgery has led to a general improvement of laser profiles, even for noncustomized tre...
PURPOSE: To describe corneal and ocular surface abnormalities in patients with congenital aniridi... more PURPOSE: To describe corneal and ocular surface abnormalities in patients with congenital aniridia. METHODS: We examined 50 eyes in 25 patients with congenital aniridia. Schirmer’s test I and II, tear film break-up time, vital staining, tear ferning pattern test and impression cytology, Cochet-Bonnet aesthesiometry, specular microscopy and ultrasonic pachymetry were carried out. RESULTS: Based on Mackman’s classification, we found grade 0 in 12%, grade 1A in 52%, grade 1B in 20%, and grade 2 in 16% cases. Age, history of ocular surgery, dry eye score and aesthesiometry correlated with the degree of aniridia-related keratopathy (ARK). Schirmer’s test I was normal in 86.8%, Schirmer’s test II in 94.4% of the eyes and TFBUT in 83.3% of the cases. Corneal staining was altered in 54.2%, and conjunctival staining was altered in 45.7%. The tear ferning pattern was abnormal in 80%. Conjunctival metaplasia was present in 76.9%, and the presence of conjunctival goblet cells on the cornea corr...
To evaluate two silicone hydrogel contact lens materials as continuous-wear bandage contact lense... more To evaluate two silicone hydrogel contact lens materials as continuous-wear bandage contact lenses after laser-assisted subepithelial keratomileusis (LASEK). The inclusion criteria were myopia of -6.00 diopters (D) or less, astigmatism lower than -1.5 D, bilateral best-corrected visual acuity of 20/20 or better, and candidates for bilateral LASEK. The patients were randomized to be fitted with a Balafilcon A (PureVision) lens in one eye and Galyfilcon A (Acuvue Advance) in the fellow eye. Uncorrected visual acuity, corneal epithelial status, conjunctival and limbal hyperemia, lens movement, contact lens debris, and the responses to a subjective-comfort questionnaire were assessed postoperatively. The parameters were evaluated before and 1 and 5 days after the procedure. A paired Student's t-test and chi-square tests were used when appropriate. We analyzed 44 eyes of 22 consecutive patients who underwent LASEK to correct low-to-moderate myopia. The mean spherical equivalent was -3.25 +/- 2.36 D. There was no difference in conjunctival or limbal hyperemia, lens movement, uncorrected visual acuity, or epithelial healing between the two lenses at any visit. A significant difference was found in lens deposition and discomfort, which were greater with the PureVision lens 5 days postoperatively (p = 0.01 for both comparisons). PureVision and Acuvue Advance contact lenses seem to be useful as continuous wear bandage contact lenses. There is no major clinical difference between the lenses, although patients report greater comfort with Acuvue Advance.
To study the effect of the learning curve of laser-assisted subepithelial keratectomy (LASEK) on ... more To study the effect of the learning curve of laser-assisted subepithelial keratectomy (LASEK) on the visual and refractive results. This retrospective study comprised 56 eyes that had LASEK for myopia. The eyes were among the first 143 that had LASEK by the same surgeon with the same excimer laser and same nomogram. The 56 eyes were separated into 2 groups. Group 1 included the first 28 eyes to have LASEK by the surgeon. Group 2 comprised the last 28 eyes in the series whose refractive error could be matched with that in Group 1. The outcomes in the 2 groups were compared. The mean preoperative spherical refraction was -3.90 diopters (D) +/- 1.90 (SD) in Group 1 and -3.70 +/- 2.53 D in Group 2 (P = .2). There were no significant differences in preoperative cylinder or best spectacle-corrected visual acuity (BSCVA) between groups. The postoperative uncorrected visual acuity (UCVA) was significantly worse in Group 1 on 1 day and 7 days postoperatively (P = .02 and P = .03, respectively); there was no significant difference at 1 month and 3 months. The safety index (postoperative BSCVA/preoperative BSCVA) and efficacy index (postoperative UCVA/preoperative BSCVA) were better in Group 2, although the difference was not statistically significant. The spherical refraction 3 months postoperatively was +0.50 +/- 0.83 D in Group 1 and +0.10 +/- 0.27 D in Group 2 (P = .02); 75.00% of eyes and 96.42% of eyes, respectively, were within +/-0.50 D of the intended correction (P = .01). Seven percent of eyes in Group 1 and no eye in Group 2 lost 2 or more lines of BSCVA. Results indicate that the outcomes of LASEK depend on surgeon experience. Thus, caution is advised when interpreting LASEK results without knowing the surgeon's level of experience.
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Papers by Laura Benito-llopis