Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty

Acar, Banu Torun; Utine, Canan Aslı; Acar, Suphi; Çiftçi, Faruk

doi:10.1016/j.jcrs.2011.12.034

Cited by 24 publications

(22 citation statements)

References 29 publications

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“…The magnitude of the baseline spherical error (range +3.0 to −13.0 D) and cylindrical error (range −2.0 to −11.0 D) of this case series reflect the wide field of power range provided by phakic IOLs. These baseline refractive values were much higher than those revealed in most of the reports of LASIK postkeratoplasty, including DALK 15,16. Moreover, the percentage of reduction in refractive astigmatism (83.8±15.8%) was higher when compared to LASIK after keratoplastly, which varies from 48% to 88% in different reports of the literature 19–24…”

Section: Discussionmentioning

confidence: 68%

“…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.…”

Section: Discussionmentioning

confidence: 92%

“…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%

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<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

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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.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 92%

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

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“…Banu Toru Acar recently reported good refractive results after either 1-step or 2-step microkeratome LASIK procedures in a retrospective 13 eyes case series. 22 To our knowledge, this is the first paper on the application of Femto-LASIK for ametropia correction in post-DALK patients using the tissue-saving or customvue or standard visx treatment. This series has demonstrated that Femto-LASIK after a corneal lamellar graft can be a safe and effective procedure.…”

Section: Discussionmentioning

confidence: 97%

Femtosecond laser-assisted in situ keratomileusis for the correction of residual ametropia after deep anterior lamellar keratoplasty: a pilot investigation

Balestrazzi

Cartocci

Menicacci

et al. 2017

Eye

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PurposeTo evaluate the refractive and visual results of one-stage laser-assisted in situ keratomileusis with femtosecond laser (Femto-LASIK) for the correction of residual ametropia after deep anterior lamellar keratoplasty (DALK).MethodsThis retrospective study included 13 eyes of 12 patients, who underwent corneal Femto-LASIK to correct refractive errors after DALK. IntraLase FS150 was used to create a lamellar flap and excimer laser ablation for refractive correction was performed using the Star S4 IR Excimer Laser in eight cases and the Technolas 217z Excimer Laser in Tissue Saving mode in five cases. Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction and corneal topography.ResultsThe mean spherical equivalent preoperatively was -4.85±2.82 (range, -9.5 to 0 D). At the last visit the mean postoperative spherical equivalent (SE) was -0.44±0.67 D (P<0.05). The mean postoperative UDVA was 0.12±0.12 logMAR. There was a statistically significant increase in CDVA 6 months after Femto-LASIK (P<0.05). Intraoperative and postoperative complications did not develop in this series of eyes.ConclusionsCorrecting the preoperative manifest refractive error with Femto-LASIK led to a significant improvement in the UDVA and CDVA without surgical complications.

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“…Separate removal of the interrupted sutures allows for good management of postoperative astigmatism. Relaxing incisions [81] , laser-assisted in situ keratomileusis [82] , or Artisan iris-fixed toric phakic intraocular lenses [83] could be good options in selective cases.…”

Section: Late Complicationsmentioning

confidence: 99%

Deep Anterior Lamellar Keratoplasty: Surgical Technique, Indications, Clinical Results and Complications

Sarnicola¹,

Sarnicola²,

Sarnicola³

2015

Cornea

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Deep anterior lamellar keratoplasty (DALK) is currently the procedure of choice to restore transparency and curvature in corneal stromal diseases with a healthy endothelium. Preserving the endothelium avoids endothelial rejection and provides a good and stable endothelial cell count, allowing good long-term graft survival. Several surgical techniques have been proposed over the last years, the most common of which include layer-by-layer manual dissection, hydrodissection, viscodissection, big bubble (needle or cannula) and air-viscobubble. Descemet's membrane rupture represents the most common complication, even in expert hands. The penetrating keratoplasty conversion rate gradually decreases as surgeons become more experienced and learn to manage Descemet's membrane ruptures. Being able to repair the ruptures would increase the success of DALK and allow patients to benefit from all of its advantages. a b cGüell JL (ed): Cornea.

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Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty

Abstract: Treatment of post-DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option.

Cited by 24 publications

References 29 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>

Femtosecond laser-assisted in situ keratomileusis for the correction of residual ametropia after deep anterior lamellar keratoplasty: a pilot investigation

Deep Anterior Lamellar Keratoplasty: Surgical Technique, Indications, Clinical Results and Complications

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