Pavel Studeny

Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S)

Aim To describe a novel technique for the preparation and transplantation of posterior corneal lamellae consisting of endothelium and bare Descemet membrane with a stromal supporting rim. Methods Posterior lamellar discs for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) were prepared manually immediately before surgery using the big bubble technique. The retrospective case series that underwent DMEK-S comprised 20 eyes of 18 patients with endothelial dysfunction. Best-corrected visual acuity (BCVA) and endothelial cell density (ECD) were measured preoperatively and 12–24 months after DMEK-S. Results At the end of the follow-up, 10 out of 18 eyes achieved a BCVA of 1.0 or better, and 17 reached 0.5 or better. Primary graft failure occurred in two eyes. The average ECD at 1 year was 1608 (±503) cells/mm2, that is, a mean cell loss from preoperative values of 44%. Partial early postoperative graft detachment (12 of 20 eyes) was treated by injecting an air bubble into the anterior chamber in all cases. The loss of donor corneas during preparation decreased from approximately 10 to 5% as more experience was acquired with the procedure. Conclusions Preliminary outcomes show that DMEK-S may be used in the treatment of corneal endothelial dysfunction. As this approach is entirely manual, and no special surgical equipment is needed, it has the potential to become widely adopted.

Comparative analysis of clinical outcomes obtained with a new diffractive multifocal toric intraocular lens implanted through two types of corneal incision.

PURPOSE To analyze and compare the clinical outcomes obtained after cataract surgery with the implantation of a new multifocal toric intraocular lens (IOL) using two different types of corneal incision. METHODS Retrospective study including 64 eyes of 35 patients who underwent surgery with implantation of the AT LISA 909M multifocal toric IOL (Carl Zeiss Meditec) in 2 different ophthalmologic centers using different criteria for corneal incision size: sub-1.8 mm (micro-incision surgery [MICS] group) and 2.2 mm (mini-incision group). Visual, refractive, and corneal topographic outcomes were evaluated during 6-month follow-up. Additionally, refractive astigmatic changes were analyzed using the Alpins vectorial method. RESULTS Significant reductions of refractive sphere and cylinder were observed postoperatively (P<.03), with associated visual improvements for near and distance (P<.01) in both groups. Mean postoperative magnitudes of difference vector, torque, and magnitude of error in the overall sample were 0.52±0.36 diopters (D), 0.36 ± 0.36 D, and 0.08 ± 0.38 D, respectively. A mean overcorrection of 4% in refractive astigmatism was found. Mean angle of error was 0.37± 5.50° and -4.51±13.16° for the MICS and mini-incision groups, respectively (P=.09). Significant positive correlations were found between the magnitudes of torque and difference vector (r=0.78, P<.01) as well as between the magnitude of torque and absolute angle of error (r=0.76, P<.01). CONCLUSIONS Implantation of the AT LISA toric IOL using corneal incisions <2.2 mm provides excellent predictability for astigmatic correction.

Treatment of Corneal Neovascularization Using Anti-VEGF Bevacizumab

Purpose. To evaluate antiangiogenic effect of local use of bevacizumab (anti-VEGF antibody) in patients with corneal neovascularization. Methods. Patients were divided into two groups. All patients suffered from some form of corneal neovascularization (NV). Patients in group A received 0.2–0.5 mL of bevacizumab solution subconjunctivally (concentration 25 mg/mL) in a single dose. Group A included 28 eyes from 27. Patients in group B applied bevacizumab eye drops twice daily (concentration 2.5 mg/mL) for two weeks. Group B included 38 eyes from 35 patients. We evaluated the number of corneal segments affected by NV, CDVA, and the incidence of complications and subjective complaints related to the treatment. The minimum follow-up period was six months. Results. By the 6-month follow-up, in group A the percentage reduction of the affected peripheral segments was 21.6% and of the central segments was 9.6%; in group B the percentage reduction of the central segments was 22.7% and of the central segments was 38.04%. In both groups we noticed a statistically significant reduction in the extent of NV. Conclusion. The use of bevacizumab seems to be an effective and safe method in the treatment of corneal neovascularization, either in the subconjunctival or topical application form.

Endothelial cell density before and after the preparation of corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim.

Purpose: To assess the endothelial cell density before and after the preparation of precut posterior corneal lamellae for Descemet membrane (DM) endothelial keratoplasty with a stromal rim with the aim of standardizing this new technique and establishing the parameters of corneas intended for manual preparation under the conditions of an ocular tissue bank. Methods: Two groups of corneoscleral buttons were used to prepare lamellae consisting of a central zone of endothelium–DM surrounded by a supporting peripheral stromal rim. Group 1 contained 12 corneas with a live endothelial cell density (LECD) of 2500 cells per square millimeter or more. Group 2 contained 10 corneas with a density of 2500 cells per square millimeter or less. The preparation was performed manually using an artificial anterior chamber. The endothelial cell density (ECD) and the percentage of dead cells were assessed before and immediately after preparation and after 48 hours of organ culture storage at 31°C. Results: Immediately after preparation, on average, 4.9% and 5.2% of dead cells were found in group 1 and group 2, respectively. After 48 hours of storage, the percentage decreased significantly in both the groups. There was no significant decrease in the ECD 48 hours after preparation in group 1; however, there was a significant decrease in group 2. The amount of tissue wasted during preparation was 24%. Conclusions: The decrease in ECD is dependent on the initial values: the cell loss is less in corneas with higher original densities. We suggest that the minimal acceptable LECD of lamellae should be 2500 cells per square millimeter.

Hybrid Technique of Lamellar Keratoplasty (DMEK-S)

Purpose: To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (DMEK-S). Materials and Methods: 71 eyes of 55 patients enrolled in a single-center study underwent posterior lamellar keratoplasty with a hybrid lamella DMEK-S implanted using a solution implantation technique, owing to endothelial dysfunction. The outcome measures studied were visual acuity and endothelial cell density. Results: The rate of endothelial cell loss caused by surgery was 43.8%. During followups, we observed the stabilization of postoperative findings, or at minimum a very low rate of corneal endothelial cell loss. The UCDVA and BCDVA dramatically improved postoperatively. The rebubbling rate in our group of patients was 61.9%. We replaced the lamella due to its failure or malfunction in 17 patients (23.9%). Conclusion: In summary, DMEK-S combines the advantages of DSEK/DSAEK and DMEK. The central zone of bare Descemets membrane and endothelium allows for very good visual outcomes, and the peripheral rim allows for better manipulation of the lamella during implantation. It is an effective method of treating the endothelial dysfunction of various etiologies, but the high complication rate needs to be addressed before widespread implementation of the technique in the future.

Descemet membrane endothelial keratoplasty with a stromal rim in the treatment of posterior polymorphous corneal dystrophy

A 20-year-old patient, diagnosed with posterior polymorphous corneal dystrophy, developed corneal edema for which he underwent Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) in the right eye. No intra- or postoperative complications were noted. At the last follow-up 2 years and 9 months after the procedure, the best corrected visual acuity was 1.0 and endothelial cell density declined from 3533 cells/mm2 to 1012 cells/mm2. Despite the endothelial cell loss, DMEK-S appears to be a good alternative to other surgical techniques for the treatment of corneal endotheliopathies, and it may be of benefit to young patients.

Opacification of a hydrophilic acrylic intraocular lens with a hydrophobic surface after air injection in Descemet-stripping automated endothelial keratoplasty in a patient with Fuchs dystrophy

A 71-year-old woman with Fuchs endothelial dystrophy in the right eye had uneventful phacoemulsification cataract surgery with implantation of a single-piece intraocular lens (IOL) (CT47S) in January 2012. Because of corneal problems and vision loss, uneventful Descemet-stripping automated endothelial keratoplasty (DSAEK) was performed in May 2013. Four months later, a new corneal lamella (repeat DSAEK) was implanted with reinjection of an air bubble into the anterior chamber. Six months after the initial DSAEK, the patient complained of blurred vision. On examination, the cornea was transparent but the IOL presented opacification in the central area. The opacified IOL was explanted and analyzed by light microscopy, which showed the presence of thin granular deposits distributed in an overall round pattern that stained positive for calcium. The opacification of hydrophilic acrylic IOLs is a complication that can occur after uneventful endothelial keratoplasty, especially when rebubbling is necessary.

Clinical experience with the WIOL-CF accommodative bioanalogic intraocular lens: Czech national observational registry.

Purpose To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL). Methods We evaluated the collected data of 48 patients with bilateral cataract surgery and Wichterle IOL (WIOL) implantation included in the Czech national observational registry. Monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity, uncorrected near visual acuity (UNVA), best spectacle-corrected visual acuity for distance (CDVA), best spectacle-corrected visual acuity for near (CNVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity were evaluated 6 months after surgery. Subjective patient satisfaction was assessed at 3 months postoperatively. Results The mean monocular UDVA was 0.074 ± 0.108 logMAR, the mean monocular CDVA was 0.047 ± 0.125 logMAR, the mean monocular UNVA was 0.328 ± 0.146 logMAR, the mean monocular DCNVA was 0.339 ± 0.131 logMAR, and the mean monocular CNVA was 0.139 ± 0.107 logMAR. A total of 24 patients (50%) had no problems with any light phenomena. A total of 18 patients were very satisfied (37.5%), 11 were satisfied (22.9%), 15 (31.2%) were rather satisfied, 4 (8.3%) were rather dissatisfied, and 0 were dissatisfied. Conclusions The WIOL–continuous focus polyfocal lens offers very good vision at far and intermediate distance comparable with other types of multifocal IOLs, and relatively good near vision, while the incidence of adverse side phenomena is relatively low.

Clinical Outcomes after Complete Intracorneal Ring Implantation and Corneal Collagen Cross-Linking in an Intrastromal Pocket in One Session for Keratoconus

Purpose. The aim of this work was to evaluate the results after combined surgery implantation of full rings and CXL in one session in a group of patients with keratoconus during a 12-month follow-up. Material and Methods. The study included 22 eyes of 20 keratoconic patients, mean age of 28.41 (from 18 to 50) years. A full ring was inserted and afterwards 0.1% riboflavin solution was injected into the corneal pocket through the incision tunnel. The cornea was irradiated with UV-A light for 30 minutes. Postoperative visits were scheduled for the first week and months 1, 3, 6, 12, and 24 after surgery. Minimal follow-up time was 12 months. Results. The mean UDVA improved by 6 lines from before the operation to 1 year after the operation, the mean CDVA improved by approximately 2.5 lines, and the mean K improved by 3.94 D. Statistically significant reductions of sphere (P < 0.001), cylinder (P = 0.004), and spherical (P < 0.001) equivalents were found 1 month after surgery. Conclusion. The combined surgery MyoRing implantation and CXL seems to be a safe method in the treatment of keratoconus. We noticed an improvement of the refractive error in all of our patients.

Safety of hydroimplantation: a foldable intraocular lens implantation without the use of an ophthalmic viscosurgical device.

Purpose To compare the safety of a single-piece, foldable intraocular lens (IOL) hydroimplantation with that of a standard implantation using an ophthalmic viscosurgical device (OVD). Methods One hundred consecutive patients with bilateral age-related cataract surgery were enrolled into a prospective double-blind study. Each patients first eye was randomly assigned to a standard implantation technique with an OVD or the hydroimplantation technique, while the fellow eye received the opposite technique. The main outcomes measured were endothelial cell loss, postoperative changes of intraocular pressure (IOP), and the frequency of complications. Results The reduction of endothelial cell density 1 month and 6 months after the surgery was 9.76% ± 13.5%, 10.7% ± 12.6%, respectively, in group A (OVD) and 9.07% ± 12.7%, 9.13% ± 13.7%, respectively, in group B (hydroimplantation). The differences were not statistically significant. The mean IOP 2 hours after surgery was 10.19 ± 6.78 mm Hg in group A and 9.92 ± 7.01 mm Hg in group B. Twenty-four hours and 1 month after surgery, the mean IOP was 14.52 ± 5.59 mm Hg and 13.21 ± 3.5 mm Hg, respectively, in group A, and 15.45 ± 5.77 mm Hg and 13.1 ± 3.44 mm Hg, respectively, in group B. The differences between groups A and B were not statistically significant. Conclusions The hydroimplantation technique is a safe technique for single-piece foldable IOL implantation. There was no increase in intraoperative and postoperative complications compared with the standard implantation technique using an OVD.