Optimization of femtosecond laser-constructed clear corneal wound sealability for cataract surgery.

PURPOSE: To compare the sealability of femtosecond laser (FSL)-assisted corneal incisions (CIs) with that of triplanar manual (M)-CIs and to determine FSL wound parameters minimizing leakage. SETTING: Private practice. DESIGN: Phase IV, single-surgeon, retrospective cohort study. METHODS: One eye per patient was included. Two groups defined by the main wound (FSL-CI or M-CI) were compared for leakage, inferred by placement of a suture at the end of surgery. Leakage in FSL-CIs was analyzed as a function of customizable wound parameters: anterior plane depth (APD), posterior plane depth (PPD), anterior side-cut angle (ASCA), and posterior side-cut angle (PSCA). The risk of leakage of FSL-CIs with optimal and nonoptimal parameters was further compared with that of M-CIs. RESULTS: A total of 1100 eyes (757 [68.8%] FSL-CI; 343 [31.2%] M-CI) were included. Wound leakage occurred in 133 FSL-CI (17.6%) and 30 M-CI eyes (8.7%) (P < .001). FSL wound parameters associated with the lowest risk of leakage were 60% APD, 70% PPD, 120 degrees ASCA, and 70 degrees PSCA. FSL-CIs constructed with at least 3 optimal parameters (60% APD, 70% PPD, and 120 degrees ASCA) had a similar risk of leakage to M-CIs (odds ratio [OR], 1.1; 95% CI, 0.5-2.3). FSL-CIs with suboptimal parameters had twice the risk of leakage of M-CIs (OR, 2.0; 95% CI, 1.1-3.8). CONCLUSIONS: Overall, FSL-CIs leaked more than M-CIs. However, FSL-CIs with optimized wound profiles had an equivalent risk of leakage to M-CIs. Wound parameter customization is an asset of FSL technology that allows optimization of FSL-CI sealability.

Outcomes of bilateral sequential implantation of the Boston keratoprosthesis type 1.

OBJECTIVE: To evaluate the risks and benefits of sequential bilateral Boston type 1 keratoprosthesis (KPro) implantation for bilateral corneal blindness. DESIGN: Comparative retrospective study. PARTICIPANTS: Patients who underwent a sequential bilateral KPro surgery. METHODS: All 11 patients who underwent sequential bilateral KPro surgery at the Centre Hospitalier de l'Université de Montréal between October 2008 and October 2011 were recruited. Data from the 22 patient eyes in our study were separated in 2 groups based on the first (group 1) or second eye (group 2) implanted with the Kpro. Both groups were then compared for the best corrected visual acuity (BCVA) and complications. Bilateral BCVA following both surgeries and the overall number of complications that affected each patient after both interventions were also analyzed. RESULTS: At 24 months, BCVA was 20/150 in group 1 and 20/200 in group 2 (p = 0.67). Throughout the study, there was no significant difference in BCVA between the 2 groups (p > 0.05), and bilateral BCVA was similar. The complication rate was comparable in the 2 groups. Patients had a mean of 2.45 complications following the first surgery and a mean of 5.27 in both eyes combined after the second intervention (p = 0.03). CONCLUSIONS: Because visual gain observed following the second surgery was the same as that with the first and multiple surgeries increased the number of complications for each patient, we recommend saving bilateral KPro implantation for cases in which the first eye with KPro develops a disease limiting its visual potential.

The Boston Keratoprosthesis type 1 as primary penetrating corneal procedure.

BACKGROUND/AIMS: Penetrating keratoplasty (PK) has a poor prognosis in certain corneal eye diseases. The safety and efficacy of Boston type 1 Keratoprosthesis (KPro) surgery as a primary penetrating corneal surgery were evaluated for patients with corneal blindness and poor prognosis for PK. METHODS: In this retrospective interventional comparative study, all patients who underwent KPro implantation by a single surgeon between October 2008 and March 2011 at the Centre Hospitalier de l'Université de Montréal were divided into two groups. Thirty patients with KPro as a primary procedure (group 1) were compared with 40 patients who had PK prior to KPro (group 2). A chart review examining preoperative and postoperative best-corrected visual acuity (BCVA), intraoperative and postoperative complications and KPro retention rate over the first postoperative year was performed. RESULTS: Preoperative BCVA was 20/200 or better in 10% of eyes in group 1 (range 20/150 light perception (LP)), and in 5% of eyes in group 2 (range 20/100 LP; p=0.42). BCVA was significantly better in group 1 throughout the follow-up (p<0.05). At 12 months, 87% and 63% of eyes achieved a BCVA better than 20/200 in groups 1 and 2, respectively (p<0.05). The complication rates and retention rate were similar in the two groups. CONCLUSIONS: This study demonstrates that the Boston KPro implantation may be successful as a primary procedure in patients at high risk of failure with traditional PK. Further, there appears to be a visual benefit to primary KPro surgery.

Perilymphatic fistulas: can we predict the diagnosis?

This study intends to identify factors that could better predict the diagnosis of perilymphatic fistula (PLF) since exploration surgery is currently the only confirmatory method. This retrospective chart review in a tertiary care center is based on all 71 available patient files operated for a suspicion of PLF between 1983 and 2012. History of predisposing factors, clinical findings and investigations were documented pre- and postoperatively. Patients were divided according to intraoperative findings into two groups: group I (fistula negative) and group II (fistula positive). In addition, group II was divided into two subgroups: patients with or without a history of stapedectomy. Both groups were demographically similar. With the exception of history of previous partial stapedectomy (p = 0.04), no statistical difference could be identified in predisposing factors and in clinical findings between the two groups. The evolution of symptoms showed an overall improvement of vestibular symptoms (91 %) and cochlear symptoms (53 %) postoperatively. Audiograms showed a significant improvement postoperatively in the pure tone audiometry and bone conduction threshold of group II while the air-bone gap and speech discrimination score did not improve. Group I did not show any significant improvement postoperatively in any audiogram parameter. This study failed to identify factors that could better predict the diagnosis of PLF. However, it shows that middle ear exploration with oval and round window obliteration is effective in PLF especially to decrease vestibular symptoms even when fistula is unidentified intraoperatively.