J Barraquer

Long‐term visual prognosis of corneal and ocular surface surgery in patients with congenital aniridia

Purpose:  To evaluate the long‐term visual prognosis of corneal and ocular surface surgery in patients with congenital aniridia.

Wedge resection for high astigmatism after penetrating keratoplasty for keratoconus: refractive and histopathologic changes.

Purpose: To analyze the refractive, topographic, keratometric changes and the histopathologic findings after wedge resection to correct high astigmatism after penetrating keratoplasty for keratoconus. Materials and Methods: A retrospective study was done analyzing the following parameters preoperatively and at 1, 3, and 5 years postoperatively: uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent and refractive, topographic, and keratometric cylinder measures. We also studied the efficacy and safety indices, as well as the histopathologic findings of tissues submitted for pathology. Results: A total of 22 eyes of 21 patients who underwent wedge resection in the host corneal tissue for correcting high irregular astigmatism after penetrating keratoplasty for keratoconus were included in the study. Mean follow-up time from penetrating keratoplasty to wedge resection was 18 years, whereas the mean follow-up time after wedge resection was 39.04 months (range, 12-280 months). The mean preoperative refractive, topographic, and keratometric cylinders were 11.58 ± 3.52 diopters (D) (range, 4.5-20 D), 10.88 ± 5.03 D (range, 2.58-21.3 D), and 11.29 ± 4.33 D (range, 4.50-18 D), respectively. The mean postoperative refractive, topographic, and keratometric cylinders at 3 years were 4.91 ± 2.48 D (range, 0.50-10 D), 3.38 ± 2.10 D (range, 2.05-7.1 D), and 5.31 ± 2.90 D (range, 0.50-9 D), respectively. The percentage of correction at 3 years of follow up was 57.5% for refractive cylinder, 68.97% for topographic cylinder, and 53.01% for keratometric cylinder. All refractive, topographic, and keratometric data showed the lowest degree of astigmatism at 3 years postoperatively, with a tendency toward regression at 5 years postoperatively. Safety index was 1.0, whereas efficacy index was 0.49. All histopathologic sections of resected tissue were consistent with keratoconus progression in the host peripheral cornea. Conclusion: Wedge resection is a safe and moderately effective procedure in the correction of high astigmatism after penetrating keratoplasty for keratoconus. Histopathologic changes confirm a true late progression of the disease in the host cornea. Keratoconus may be a disease that affects the entire cornea, and surgical resection does not cure the disease.

Storage, surgery, outcome, complications, and new developments in corneal and conjunctival grafts.

This review covers last years literature on corneal, limbal, and conjunctival transplantation including tissue storage and eye banking. In this area, the main themes were related to a better evaluation of tissue viability and the exclusion of disease transmission. An analysis of the changing indications for penetrating keratoplasty shows the differences between American and European series. Most efforts in relation to surgical techniques are oriented toward obtaining better refractive results, whereas the study of large series sheds new light on the risk factors for graft failure and other complications. Limbal transplants have acquired the status of a new field in the surgical treatment of ocular surface disease, particularly in relation to corneal stem cell deficiencies.

Evolution of cataract surgery: Barraquer experience

Purpose To describe the evolution of cataract surgery at the Barraquer Eye Center

Boston KPro experience in Barcelona

Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered.