Navegando por Palavras-chave "deep anterior lamellar keratoplasty"
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- ItemSomente MetadadadosDeep anterior lamellar transplant using lyophilized and optisol corneas in patients with keratoconus(Lippincott Williams & Wilkins, 2008-10-01) Farias, Roberta [UNIFESP]; Barbosa, Luciene [UNIFESP]; Lima, Acacio; Mayumi, Eliane; Lourenco, Andrea; Freitas, Denise de [UNIFESP]; Allemann, Norma; Vieira, Luis; Universidade Federal de São Paulo (UNIFESP); Sorocaba Eye BankPurpose: Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.Methods: Ten eyes underwent DALK and received corneas that had been lyophilized, and 10 eyes received corneas kept in Optisol. Follow-up examinations included measurement of visual acuity (VA; Early Treatment Diabetic Retiropathy Study chart), topography, pachymetry, specular microscopy, constrast sensitivity, and confocal micorscopy.Results: All vairables improved similarly in both groups, without statistical differences between them, except for the uncorrected VA in the sixth postoperative month, which was better in the lyophilized group (0.46) compared with Optisol group (0.70). the best spectacle-corrected VA was 0.16 in the lyophilized group and 0.26 in the Optisol group. the mean endothelial cell count during the sixth postoperative month was 2778.5 in the lyophilized group and 2611.5 in the Optisol group. Optisol corneas had greater keratocyte density, and the keratocyte density improved in lyophilized corneas during follow-up.Conclusion: Lyophilized corneas can be used successfully for DALK to treat keratoconus with results similar to Optisol corneas.
- ItemAcesso aberto (Open Access)Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus(Ijo Press, 2018) Macedo, Jarbas Pereira de [UNIFESP]; Oliveira, Lauro Augusto de [UNIFESP]; Hirai, Flávio Eduardo [UNIFESP]; Sousa, Luciene Barbosa de [UNIFESP]AIM: To compare the functional and anatomic results of femtosecond laser (FSL)-assisted deep anterior lamellar keratoplasty (DALK) associated with phototherapeutic keratectomy (PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus. METHODS: During the first phase of the study, an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups: in FSL group, FSL lamellar cuts were performed on two corneas and in FSL+ PTK group, PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made. During the second phase of the study, a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus: group 1 (n= 14 eyes) underwent FSL-assisted DALK associated with PTK and group 2 (n= 12 eyes) underwent FSL-assisted DALK associated with the big-bubble technique. The main outcome measures were the postoperative visual acuity (VA) and optical coherence tomography (OCT) measurements, confocal microscopic findings, and contrast sensitivity. RESULTS: In the pilot study, histopathology showed a more regular stromal bed in the FSL+ PTK group. In the clinical trial, group 1 had significantly worse best spectacle-corrected VA and contrast sensitivity (P< 0.05 for both comparisons). The residual stromal bed measured by OCT was significantly (P< 0.05) thicker in group 1. Confocal microscopy detected opacities only at the donor-receptor interface in group 1. CONCLUSION: Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.
- ItemSomente MetadadadosPediatric corneal transplants(Lippincott Williams & Wilkins, 2017) Trief, Danielle; Marquezan, Maria C. [UNIFESP]; Rapuano, Christopher J.; Prescott, Christina R.Purpose of reviewPediatric keratoplasty poses unique challenges in clinical and surgical management. However, successful transplantation can afford a child vision in an otherwise poorly seeing eye. This review will provide an update on recent advances in pediatric keratoplasty.Recent findingsAlthough children who receive corneal transplants remain at increased risk of rejection, infection, and graft dehiscence compared with adult corneal transplant recipients, new surgical techniques, and advances in clinical management have led to better outcomes. Surgical modifications in penetrating keratoplasty (PKP) offer increased stabilization of the delicate pediatric eye. Lamellar surgery, including endothelial keratoplasty and deep anterior lamellar keratoplasty, can target specific diseased tissue in children with potentially fewer complications. The keratoprosthesis can be used successfully in children when the chance of success with PKP is especially low.SummaryAs our knowledge of prognostic indicators and surgical techniques continues to grow, we can offer children safer and more targeted surgeries for some of the most challenging corneal diseases. Ultimately, successful transplantation with long-term graft survival can be obtained by a multidisciplinary approach, with care across ophthalmic specialties, and a commitment to long-term follow-up by the patient's family.
- ItemSomente MetadadadosRetained Host Descemet Membrane (Auto-DMET) During Conversion of Deep Anterior Lamellar Keratoplasty to Penetrating Keratoplasty: A Case Report(Lippincott Williams & Wilkins, 2014-08-01) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Woreta, Fasika; Kiely, Amanda E.; Jun, Albert S.; Johns Hopkins Sch Med; Universidade Federal de São Paulo (UNIFESP); Universidade do Estado do Rio de Janeiro (UERJ)Purpose: The aim of this study was to relate a case of deep anterior lamellar keratoplasty (DALK) converted to penetrating keratoplasty in which the host central Descemet membrane (DM) with a large perforation was left attached to the host cornea.Methods: This is a case report of a 34-year-old man who underwent an attempted DALK for keratoconus in his left eye, which became complicated with a large rupture in DM during dissection. The host DM was left in place, the donor cornea with DM intact was sutured onto the host bed, and air was injected into the anterior chamber. The patient was monitored by biomicroscopy, pachymetry, topography, anterior segment optical coherence tomography, and specular microscopy.Results: The postoperative course resulted in improved uncorrected visual acuity, best spectacle-corrected visual acuity, and topography. Corneal edema was observed in the host cornea peripheral to the graft. Three months after the surgery, the endothelial cell density was reduced by 63% compared with the preoperative donor cell density.Conclusions: Leaving the host DM during conversion of DALK to penetrating keratoplasty was uneventful in this case, although corneal edema was observed in the area overlying the host cornea. It is possible that the retained DM could provide additional autologous endothelial cells to prolong graft survival.