ABSTRACT
Purpose: To compare the functional and anatomical outcomes (in terms of graft uptake and rejection/failure) of deep anterior lamellar keratoplasty (DALK) in stromal corneal dystrophy (macular and granular). Methods: Sixteen eyes with macular corneal dystrophy (MCD; group A) and 10 eyes with granular corneal dystrophy (GCD; group B) underwent successful DALK by big bubble technique or layer-by-layer dissection. Results: Both groups showed significant improvement in their best-corrected visual acuity postoperatively (postoperative P value in MCD and GCD was 0.00001 and 0.0008, respectively) with no statistically significant differences between the two groups (P = 0.77) at 1 year. Postoperative endothelial count did not drop significantly in group A (MCD, P= 0.1553). Only in seven eyes preoperative endothelial count could be obtained (due to dense stromal corneal opacity), but there was a significant endothelial count difference between preoperative and postoperative count in group B (GCD, P= 0.0405) at the end of 1 year postoperatively which could be because of age and stage of disease (advanced granular dystrophy) and also because of small sample size of GCD compared with MCD. Intergroup comparison between the two groups showed no statistically significant difference (P = 0.6353) with good postoperative outcome in both groups. Conclusion: DALK can be successfully done in both groups and results are comparable. However, long-term outcomes on a large scale need to be further evaluated.
ABSTRACT
Purpose: The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique. Methods: The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010�. Results: The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1� years). The mean preoperative distance deviation was 46.7 � 10.4 prism diopters (PD) for exotropic patients and 47.1 � 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 � 11 PD for exotropic patients and 52.4 � 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia. Conclusions: This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.
ABSTRACT
Purpose: To evaluate functional and anatomical outcome in patients undergoing deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet's membrane (DM) perforation (macro and micro). Methods: A retrospective cross sectional study (January 2009 to December 2015) of sixteen eyes of sixteen patients which included nine patients of advanced keratoconus (KC), two patients with paracentral DM scarring post hydrops, KC with Bowman's membrane scarring, macular corneal dystrophy and one patient of advanced Pellucid Marginal Degeneration (PMD). All underwent DALK with intraoperative DM perforation. Big bubble technique was attempted in all except in the two patients with post hydrops DM scar. Preoperative and postoperative best corrected visual acuity (BCVA), astigmatism and endothelial count (EC) were compared. Results: Postoperative BCVA and astigmatism were found to be better and statistically significant ('p value' 0.00 and 0.003 respectively). BCVA preoperative and postoperative was 1.07± 0.3 and 0.28 ± 0.09 in LogMAR respectively and astigmatism pre and postoperative 4.14 ± 1.5 D and 2.7 ± 0.97 D respectively. Percentage decrease in EC at sixth postoperative week was 7.48% and at sixth month and 1 year postoperative was 15.1%. Two patients developed postoperative double anterior chamber and two patients developed pupillary block glaucoma and all were successfully managed. Conclusion: Not all patients of intraoperative DM perforation (including macro perforation) needs to be converted to penetrating keratoplasty. DALK can be successfully done if the perforation is identified early and managed adequately. This is the only known study which has shown a large series of successful DALK even with macro perforations.
ABSTRACT
Purpose: The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue. Methods: In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema. Results: The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded. Conclusion: Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium.