James Ball

Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus.

AimTo compare the outcomes and complications of deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) for keratoconus.MethodsA cohort of 20 consecutive PKs, for keratoconus, was compared with 20 consecutive DLKs, for keratoconus. The PKs were performed between June 2000 and July 2001, the DLKs between October 2001 and October 2002. Surgery was performed by one surgeon. Best-corrected visual acuities (BCVA), refraction and complications were recorded at the time of surgery, 6 and 12 months postoperatively. χ2-tests were used to compare visual acuity outcomes and independent t-tests in the analysis of astigmatism.ResultsGroups were comparable for age, sex, and ethnicity. All PKs were uncomplicated. Two of the DLK group had microperforations of Descemets membrane. There was no significant difference in the proportion of patients achieving 6/9 or better between the PK and DLK groups (85 vs 78%, P=0.54). PK patients were, however, more likely than the DLKs to achieve 6/6 at 1 year; 70% (14/20) of PKs compared to 22% of (4/18) DLKs (P=0.04). Astigmatism was significantly higher in the PKs compared to the DLKs (P=0.022). There were two cases of graft rejection in the PK group, while none in the DLKs.ConclusionsThis study confirms good visual results from both PK and DLK in keratoconus with similarly high percentages reaching 6/9 BCVA. DLK appears to cause less astigmatism and also has the advantage of no endothelial graft rejection. The apparent cost, however, is a reduction in the likelihood of achieving 6/6 BCVA.

Mid-term outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK).

Mid-term outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK)

Modified draping technique for topical anaesthesia ophthalmic surgery

We describe a simple modified technique for draping the eye in cataract surgery under topical anaesthesia. This method minimizes prolapse of the eyelashes into the surgical field without compromising patient comfort and confers several advantages over previously used techniques.We describe a simple modified technique for draping the eye in cataract surgery under topical anaesthesia. This method minimizes prolapse of the eyelashes into the surgical field without compromising patient comfort and confers several advantages over previously used techniques.

Pressure dependent stromal oedema following deep anterior lamellar keratoplasty

A 53 year old man with keratoconus and a steroid related intraocular pressure response developed acute hydrops and underwent deep anterior lamellar keratoplasty after poor spontaneous recovery of vision. Intraocular pressure rose to 40 mm Hg on postoperative administration of topical prednisolone 0.5%, resulting in a well localised area of stromal oedema. Resolution of the oedema followed reduction of intraocular pressure, but recurrence ensued if the pressure rose above 30 mm Hg. Following acute hydrops, the regenerative process involves endothelial proliferation across the break in Descemet’s membrane. This localised functional deficit is demonstrated after only a moderate intraocular pressure rise. A 53 year old man was referred with acute hydrops in the left eye. He had a history of asthma, severe atopic keratoconjunctivitis, keratoconus, …

Keraring implantation using the Zeiss Visumax femtosecond laser in the management of patients with keratoconus

PurposeTo evaluate the safety and efficacy of implanted Kerarings in patients with mild, moderate, and severe keratoconus.Patients and methodsA 12-month retrospective case series of 70 eyes of 70 patients who underwent Keraring implantation with the Zeiss Visumax femtosecond laser. Patients were stratified into three groups according to their topography as mild (mean K <48 D) moderate (48–55 D) or severe (>55 D). Main outcome measures were visual acuity, manifest refraction, and corneal topography. Complications were recorded.ResultsA total of 66 patients completed the 12-month follow-up. In all, 4 rings were explanted, 3 due to no improvement in visual function and 1 due to corneal neovascularization. Also, 4 rings were repositioned. In mild disease (n=28), BCVA increased to 0.10 logMAR, sphere decreased to −1.54 D, cylinder decreased to 2.54 D, Kmax decreased to 46.25 D, and keratometric astigmatism to 3.88 D (P<0.01 for each compared with preoperative values). No patients lost vision. In moderate disease (n=27), sphere decreased to −4.06 D, cylinder decreased to 3.47 D, Kmax decreased to 51.69 D, and keratometric astigmatism to 4.56 D (P<0.05 for each compared with preoperative values). In severe disease (n=11), BCVA increased to 0.34 logMAR, Kmax decreased to 57.65 D, and keratometric astigmatism to 5.07 D (P<0.05 for each compared with preoperative values).ConclusionFemtosecond laser-assisted Keraring implantation is a safe and minimally invasive treatment option to improve the refraction and visual function in patients with keratoconus. Patients with mild keratoconus are more likely to have a favourable outcome following Keraring implantation.