Trypan blue-assisted corneal allogenic intrastromal ring segment implantation

J Cataract Refract Surg

Dockery

Jacob

et al. 2021

Self Cite

Corneal allogenic intrastromal ring segments (CAIRS) are semicircular pieces of donor corneal stroma, which may be surgically implanted to flatten keratoconic corneas. These segments can be trimmed to different thicknesses; whereas thicker segments confer greater flattening, their bulk renders them more technically challenging to insert. Consequently, thinner segments are often preferred, especially for starting surgeons. Here, we describe a technique for transiently thinning CAIRS to facilitate easy insertion, thereby permitting the use of thicker segments to achieve the maximal flattening effect.

Section: Surgical Techniquementioning

confidence: 99%

Preimplantation dehydration for corneal allogenic intrastromal ring segment implantation

J Cataract Refract Surg

Dockery

Jacob

et al. 2021

Self Cite

“…1 In brief, corneoscleral buttons are debrided of epithelium and endothelium using surgical sponges, either cellulose (Weck-Cel, Beaver-Visitec International) or the potentially less likely to fragment polyvinyl acetal (Merocel, Beaver-Visitec International), trephinated using dedicated CAIRS trephines (Jacob CAIRS trephine, Madhu Instruments), and bisected into semicircular segments, which are stained with 0.06 trypan blue (Vision Blue, DORC International). 2 The segments are then rinsed with saline and placed on a dry surgical sponge, while the recipient eye is prepared. 3 Under general anesthesia, a handheld pachymeter (PachPen, Accutome, Inc.,) measures corneal thickness at the primary incision, 2.0 mm inside the temporal limbus.…”

Section: Surgical Techniquementioning

confidence: 99%

Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation

Dockery

J Cataract Refract Surg

2021

Self Cite

Corneal allogenic ring segments are semicircular pieces of donor corneal stroma that may be surgically implanted to flatten keratoconic corneas. Conventionally, these donor segments are inserted into channels created using femtosecond laser dissection. However, access to femtosecond technology is not universal. In this study, an alternate, manual technique for channel creation, which is femtosecond laser independent, is described.

“…Additionally, the original technique combined ring segment implantation with UVCXL by first soaking the segments in a riboflavin solution, which acts as the photosensitizer during crosslinking but also aids in visualization of the segment during implantation [116]. Where combination of these 2 procedures is not possible, the CAIRS segments can be rinsed in trypan blue to assist with segment visualization [117]. So, while UVCXL and ICRS still remain the standard for eyes with mild to moderate KC, these innovative corneal grafting techniques may provide minimally invasive options for patients with even advanced KC [118].…”

Section: Anterior Lamellar Keratoplastymentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

et al. 2021

For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation – inlay and more recently onlay techniques – has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a “postkeratoplasty” world.