Excimer laser mushroom penetrating keratoplasty: new technique.

PURPOSE: To evaluate retrospectively the outcomes of 15 consecutive mushroom-shaped penetrating keratoplasties performed by using excimer laser for both the recipient bed and the fresh donor corneas. METHODS: Fifteen eyes of 14 patients who underwent excimer laser mushroom-shaped penetrating keratoplasty from October 13, 2010, to October 14, 2011, were included in our retrospective study. Eight were men and 6 were women, with a mean age of 31.45 ± 6.52 (range 27-65) years. Eleven (73.3%) had postinfective central deep corneal scar; 4 (26.7%) had severe keratoconus with Descemet opacity. RESULTS: The mean follow-up was 11.9 ± 2.7 months. The mean preoperative best-corrected visual acuity (BCVA) was 0.15 ± 0.16; the postoperative BCVA was 0.69 ± 0.24 after 12 months with a mean refractive astigmatism of 1.8 ± 1.1 D. The mean preoperative endothelial cell count of the donor corneas was 2297.0 ± 189.7 cells/mm²; after 12 months, it was 1906.5 ± 165.8 with a decrease of 17.0%. No intraoperative complications occurred. CONCLUSIONS: Our results showed that excimer laser mushroom penetrating keratoplasty is safe. Furthermore, it does not appear to influence the visual outcomes of the penetrating keratoplasty surgery. This technique is useful for those who use an excimer laser.

Deep anterior lamellar keratoplasty with dehydrated, 4 °C-stored, and rehydrated lenticules.

PURPOSE: To retrospectively evaluate the outcomes of 124 consecutive deep anterior lamellar keratoplasties (DALK) performed by using dehydrated, 4 °C stored, and rehydrated lenticules. METHODS: A total of 124 eyes of 109 patients, which had undergone DALK from August 11, 2000, to December 13, 2007, were included in our retrospective study; 88 cases were male and 36 female, with a mean age of 39.45±15.52 years (range 6-85). A total of 109 (87.9%) had keratoconus, 7 (5.6%) had deep or superficial corneal scar, 3 (2.4%) had epikeratophakia, 3 (2.4%) had pellucid degeneration, 1 (0.8%) a malignant pterygium, and 1 (0.8%) had a severe alkali burn. All the patients underwent ophthalmic examinations, including best-corrected visual acuity (BCVA), central ultrasound pachymetry, computerized topography, specular microscope endothelial cell count, and confocal microscopy. RESULTS: The mean follow-up was 23.9±3.4 months. The mean preoperative BCVA was 0.16±0.18; the postoperative BCVA was 0.68±0.20 after 2 years. The mean preoperative central corneal thickness (CCT) was 439.4±10.5 µm; after 2 years, it was 532.1±9.7 µm. The mean preoperative endothelial cell count (ECC) was 2301.3±180.2 cells/mm2; after 2 years it was 1986.0±169.5 with a decrease of 13.7%. Baring of Descemet membrane (DM) during DALK was achieved in 112 (90.32%) eyes; 4 eyes (3.26%) had a large perforation of the DM with consequent PK. Small intraoperative perforation of DM during DALK occurred in 18 cases (14.52%). CONCLUSIONS: The results showed that the method of preservation and distribution of dehydrated, 4 °C stored, and rehydrated lenticules is safe, cheap, and simple. Furthermore, it does not appear to influence the outcomes of the DALK surgery.

Enzymatic descemetic lamellar keratoplasty: pilot study.

PURPOSE: This was a pilot study to evaluate the efficacy of a new surgical technique of descemetic anterior lamellar keratoplasty (DALK) with the help of enzymatic hyaluronidase solution. METHODS: We selected 10 patients, 6 male and 4 female, with surgical keratoconus, with a mean age of 45+/-16 years (range 29-61), with best-corrected visual acuity (BCVA)

Implantation and capsular bag stability of single-piece, foldable EasAcryl 1 intraocular lenses.

PURPOSE: To assess the folding and implantation of the single-piece EasAcryl 1 intraocular lens (IOL) and the maintenance of the tunnel structure and capsular bag stability after implantation. SETTING: S. Orsola Hospital Department of Pathophysiologic Optics, University of Bologna, Bologna, Italy. METHODS: This study comprised 300 cases of EasAcryl 1 IOL implantation. First, a 3.2 mm corneal incision was made according to preoperative astigmatism followed by a 5.5 mm +/- 0.3 (SD) capsulorhexis. After sutureless phacoemulsification using a venturi pump, the 6.0 mm optic, 11.0 mm diameter IOL was implanted using a hexagonal cartridge. The IOLs were implanted using a 2-step maneuver when the superior haptic was grasped with the forceps (first case) or a 1-step maneuver when only the Microsert injector was used. The cartridge was never pushed beyond the tunnel. The preoperative and postoperative incision size and the corneal surgically induced astigmatism were recorded. The IOL rotation was measured 30 +/- 5 days and 8 +/- 1 months postoperatively. RESULTS: No intraoperative complications occurred after the learning curve. No alteration in astigmatism was observed. The mean IOL rotation was 1.04 +/- 0.5 degrees at 30 +/- 5 days and 1.02 +/- 0.2 degrees at 8 +/- 1 months. CONCLUSIONS: The EasAcryl 1 was easily implantation through a 3.2 mm tunnel without altering the natural architecture. The unfolding of the IOL was well controlled, and the IOL remained well centered. A short learning curve is required.