Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet’s stripping automated endothelial keratoplasty

Tomida, Daisuke; Yamaguchi, Takefumi; Ogawa, Akiko; HIrayama, Yumiko; Shimazaki-Den, Seika; Satake, Yoshiyuki; Shimazaki, Jun

doi:10.1007/s10384-015-0388-y

Cited by 24 publications

(13 citation statements)

References 35 publications

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“…We demonstrated that HOAs caused by a graft fold in the posterior surface degraded visual acuity after DSAEK. 47 The effect of folds in the posterior surface is not negligible for postoperative visual acuity. We sometimes find graft folds just after the insertion of the DSAEK graft into the anterior chamber.…”

Section: From Theory To Clinical Applicationmentioning

confidence: 99%

Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation

Yamaguchi

Satake

Doğru

et al. 2015

Cornea

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An understanding of corneal optics is important to optimize the visual outcome after eye surgery. Recent advances in the surgical techniques of lamellar keratoplasty have changed the strategies used for corneal transplantation. Lamellar keratoplasty has the advantage of having a lower rate of graft rejection, superior biomechanical properties, and reduced higher-order aberrations (HOAs) compared with penetrating keratoplasty; thus, the use of lamellar keratoplasty has increased over the last 15 years. However, some patients have poor postoperative visual acuity despite a clear cornea, and the reasons for the poor visual outcome are poorly understood. By combining corneal imaging technologies and the latest optical software, we proposed the concept of "parallelism of anterior and posterior surfaces in lamellar keratoplasty." In physiologically normal eyes, in which the anterior and posterior surfaces are parallel to each other, the posterior surface of the cornea compensates the HOAs of the anterior surface, and this is also true in eyes after penetrating keratoplasty. However, after lamellar keratoplasty, in which the anterior and posterior surfaces are independent and not parallel, irregularities in the posterior surface increase the HOAs of the anterior surface. This article introduces this concept to enhance our understanding of visual optics in eyes after penetrating and lamellar keratoplasties and how to apply this concept to surgery to improve and optimize patient visual outcomes.

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Section: From Theory To Clinical Applicationmentioning

confidence: 99%

Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation

Yamaguchi

Satake

Doğru

et al. 2015

Cornea

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“…The use of microkeratome in DSAEK procedure is beneficial in terms of decreased astigmatism, rapid visual recovery, and reduced rejection rate. [ 92 ] In a post-DSAEK cornea, the posterior surface of the cornea is not parallel to the anterior surface of the DSAEK donor tissue. This leads to increase in the higher order aberrations of up to 25%.…”

Section: Descemet's Stripping Endothelial Keratoplastymentioning

confidence: 99%

Lamellar keratoplasty techniques

Singh

Said

Dua

2018

Indian J Ophthalmol

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Lamellar keratoplasty (LK) has revolutionized corneal graft surgery in several ways. Deep anterior LK (DALK) has eliminated risk of failure due to endothelial rejection. Endothelial keratoplasty (EK) has almost eliminated induced astigmatism and the “weak” graft–host junction as seen with penetrating keratoplasty (PK) and also reduced the risk of endothelial rejection. LK provided new insights into posterior corneal anatomy that led to better understanding and performance of DALK and to the development of another EK procedure, namely pre-Descemet's EK (PDEK). Surgical procedures for LK were further refined based on the improved understanding and are able to deliver better surgical outcomes in terms of structural integrity and long-term patient satisfaction, reducing the need of further surgeries and minimizing patient discomfort. In most specialist centers, anterior lamellar techniques like DALK and EK techniques like Descemet's stripping EK (DSEK) and Descemet's membrane EK (DMEK) have replaced the full-thickness PK where possible. The introduction of microkeratome, femtosecond laser, and PDEK clamp have made LK techniques easier and more predictable and have led to the innovation of another LK procedure, namely Bowman membrane transplant (BMT). In this article, we discuss the evolution of different surgical techniques, their principles, main outcomes, and limitations. To date, experience with BMT is limited, but DALK has become the gold standard for anterior LK. The EK procedures too have undergone a rapid transition from DSEK to DMEK and PDEK emerging as a viable option. Ultrathin-DSEK may still have a role in modern EK.

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“…The irregular posterior corneal surfaces are supposed to result in an increase in total HOAs and degraded quality of vision. [ 16 ] However, to the best of our knowledge, the influence of HOAs on visual acuity is still poorly understood in eyes with corneal dystrophies. In the following study, we hypothesized that increased HOAs have adverse effects on the visual acuity in corneal dystrophies, although the reason for decreased visual acuity in these corneal dystrophies have been thought to be due to the stromal opacities.…”

Section: Introductionmentioning

confidence: 99%

Corneal Higher Order Aberrations in Granular, Lattice and Macular Corneal Dystrophies

et al. 2016

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PurposeTo evaluate the corneal higher-order aberrations (HOAs) in granular, lattice and macular corneal dystrophies.MethodsThis retrospective study includes consecutive patients who were diagnosed as granular corneal dystrophy type2 (GCD2; 121 eyes), lattice corneal dystrophies type 1, type 3A (LCDI; 20 eyes, LCDIIIA; 32 eyes) and macular corneal dystrophies (MCD; 13 eyes), and 18 healthy control eyes. Corneal HOAs were calculated using anterior segment optical coherence tomography, and the correlations between HOAs and visual acuity were analyzed.ResultsHOAs of the total cornea within 4 mm diameter were significantly larger in GCD2 (0.17 ± 0.35 μm), in LCDI (0.33 ± 0.27), LCDIIIA (0.61 ± 1.56) and in MCD (0.23 ± 0.18), compared with healthy controls (0.09 ± 0.02μm, all P < 0.01). HOAs of the total cornea within 6 mm diameter were significantly larger in GCD2 (0.32 ± 0.48), in LCDI (0.60 ± 0.46), LCDIIIA (0.83 ± 2.29) and in MCD (0.44 ± 0.24), compared with healthy controls (0.19 ± 0.06, all P < 0.001). In GCD2, there was no significant correlation between logMAR and HOAs (r = 0.113, P = 0.227). In MCD, LCDI and LCDIIIA, logMAR was positively significantly correlated with HOAs (r = 0.620 and P = 0.028, r = 0.587 and P = 0.007, r = 0.614 and P < 0.001, respectively).ConclusionsIncreased HOAs occur in eyes with corneal dystrophies, especially in eye with LCD and MCD. Larger amount corneal HOAs are associated with poorer visual acuity in patients with LCD and MCD.

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Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet’s stripping automated endothelial keratoplasty

Abstract: Visual outcomes after f-DSAEK were poor compared to conventional m-DSAEK due to an increase in irregular astigmatism caused by posterior surface irregularities.

Cited by 24 publications

References 35 publications

Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation

Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation

Lamellar keratoplasty techniques

Corneal Higher Order Aberrations in Granular, Lattice and Macular Corneal Dystrophies

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