Clear Corneal Tunnel Incision Research Articles

Post-Operative Astigmatism Using Clear Corneal Tunnel Incision in Children with Developmental Cataract

Post-Operative Astigmatism Using Clear Corneal Tunnel Incision in Children with Developmental Cataract

CM T – Flex intraocular lens an innovative design for aphakia secondary to postcataract surgery

Here, we report a case of 66-year-old female who came with a history of secondary aphakia due to the complication of cataract surgery in the left eye with a vision of HM + which is improving with pinhole to 6/9 and right eye PCIOL with a vision of 6/6, managed with new foldable acryflex T IOL (CM T FLEX) scleral fixated intraocular lens (IOL). Two partial-thickness limbal-based scleral flaps of 2.5 mm × 2.5 mm were created 180° apart; sclerotomies were made using 23G needle 1.5 mm away from the limbus. The new acryflex T–flex IOL implantation was performed through the 2.8 mm clear corneal tunnel incision, and T-shaped IOL haptics were externalized with the 23G forceps under the scleral flap. Fibrin glue was used to close the scleral flaps and conjunctiva. Postoperative period was uneventful; at the end of 1 month, the patient regained a good visual acuity of 6/6 (P) with a good stable centration of IOL.

Clinical evaluation of surgery-induced astigmatism in cataract surgery using 2.2 mm or 1.8 mm clear corneal micro-incisions.

To evaluate corneal astigmatism after phacoemulsification using 2.2 mm or 1.8 mm clear corneal micro-incisions and its effects on visual function. Sixty cases (60 eyes) with cataract were randomly divided into groups A (n=30) and B (n=30) respectively underwent 2.2 mm and 1.8 mm clear corneal tunnel incision phacoemulsification combined with folding intraocular lens implantation from the time direction of 11:00. On day 1 and at 1, 4, and 6wk after operation, patients' vision was measured and both the corneal curvature and corneal thickness (CT) were recorded using Pentacam. The measured surgery-induced astigmatism (SIA) in both groups A and B peaked on day 1 after operation, and then gradually decreased and eventually stabilized in week 4. No statistically significant difference was found in corneal astigmatism between two groups (P>0.05). The measured corneal astigmatism at 4wk and 6wk postoperatively were 0.28±0.09 D and 0.27±0.10 D for groups A and 0.27±0.09 D and 0.25±0.10 D for groups B without statistically significant difference (P>0.05). In addition, no significant differences in visual acuity and CT were found between groups A and B before or after operation. Both 2.2 mm and 1.8 mm micro-incision cataract surgeries result in relatively small SIA with no difference in visual function and corneal astigmatism between two surgery approaches. Thus, the two types of surgical systems are safe and efficient for cataract treatment, by which satisfactory uncorrected visual acuity can be regained early postoperatively.

25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body.

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

Comparison of the influence on tear film between scleral tunnel incision and clear corneal tunnel incision in phacoemulsification

Comparison of the influence on tear film between scleral tunnel incision and clear corneal tunnel incision in phacoemulsification

Comparison between Clear Corneal Incision and Scleral Tunnel Incision in Phacoemulsification on basis of post-surgical outcomes

To compare post-surgical astigmatism induced by phacoemulsification through 2.8mm clear corneal incision at steep axis versus superior scleral tunnel incision. This study was performed on 200 eyes of 198 patients of cataract reporting at Eye Department, SRMSIMS, Bareilly from July 2015 to December 2015. They were randomly assigned to two groups: Group A, 2.8mm clear corneal incision at steep axis group and Group B, the superior scleral tunnel incision group. Induced refractive change caused by corneal incision at steep axis showed an overall improvement in pre-operative astigmatism with minimum level of significance while post-surgical astigmatism induced by scleral tunnel incision was found out to be minimal with a good visual rehabilitation. Corneal incision at steep axis is an effective technique to reduce pre-operative astigmatism while scleral tunnel technique is suitable in cases where minimal change in pre-operative astigmatism is targeted.

Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases.

Purpose. To describe our technique, clear corneal phacovitrectomy with posterior capsulorhexis (CCPV), for the management of selected posterior segment intraocular foreign body (IOFB), posteriorly dislocated lens fragments (PDLF), and proliferative diabetic retinopathy (PDR) cases. Methods. This was a single-center retrospective interventional case series. In 21 patients (21 eyes) we performed phacovitrectomy through three clear corneal tunnel incisions (CCTI) and posterior capsulorhexis to remove IOFB (n = 8), PDLF from the vitreous cavity after complicated phacoemulsification (n = 6), and vitreous hemorrhage and epiretinal membranes in PDR (n = 7). The procedure was completed with implantation of a hydrophobic acrylic IOL through the CCTI. Results. The mean visual acuity (logMAR) was 0.90 preoperative and improved to 0.26 over a mean follow-up of 8.7 months (range, 6–12 months). The intraocular lens was implanted into the capsular bag (n = 12) or onto the anterior capsule (n = 9). One PDR patient experienced an intraprocedural complication, hemorrhage from isolated fibrovascular adhesions. One IOFB patient developed apparent anterior proliferative vitreoretinopathy and required a repeat intervention. Conclusion. Selected vitreoretinal IOFB, PDLF, and PDR cases can be successfully managed by a combined surgical approach involving clear corneal phacovitrectomy with posterior capsulorhexis and implantation of an IOL, with good visual outcome and a low complication rate.

Modified Scleral Suture Fixation Technique for Foldable IOL with Fenestrations in the Proximal Part of the Haptics

To present a modified surgical technique for scleral suture fixation of a new foldable intraocular lens (IOL) design with fenestrations in the proximal part of the haptics. An experimental model of a double continuous-loop 4-point scleral suture fixation of IOL with fenestrations in the proximal part of the haptics showed that with conventional techniques, the lens is located in a horizontal plane 90° to the expected iris plane. To achieve proper IOL positioning, we modified the technique so as to perform 2 needle passes through the sclera for each haptic in the same meridian, resulting in the external part of the suture being radial to the limbus. The technique was performed in 14 eyes. Mean follow-up time was 9.8 months. In all cases, the lens was successfully implanted through clear corneal tunnel incision and the scleral fixation, as mentioned above, was performed with the use of Hoffman scleral pockets. Good centration of the IOLs without signs of tilt was achieved. It is possible to decrease the risk of tilt of the IOL with fenestrations in the proximal part of the haptics by modifying the technique so that the 2 needle passes through the sclera for each haptic are done in the same meridian, resulting in a layout of the external part of the suture being radial to the limbus.

In vitro immunohistochemical and morphological observations of penetrating corneal incisions created by a femtosecond laser used for assisted intraocular lens surgery

To compare inflammatory cell response and morphological aspects of femtosecond laser-created corneal incisions. Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. Experimental study. In 16 of 22 human corneoscleral buttons, clear corneal tunnel incisions were created using a femtosecond laser (Lensx) with 7 μJ laser pulse energy on the outer periphery and manually using a phaco knife on the respective opposite side (180 degrees). In 6 corneas, no treatment was performed (controls). Corneas were then kept in organ culture for 12 or 48 hours, and the inflammatory reaction was evaluated using standard immunofluorescence analyses for monocytes (CD11b) and for dendritic cells (HLA-DR). For morphological analyses and apoptosis, van Gieson staining and terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was performed. There were no statistically significant differences in inflammatory cell response between femtosecond laser corneal incisions and manually performed incisions. Apoptosis was significantly more pronounced in the femtosecond incisions. The ratio of dendritic cells between femtosecond incisions and manual incisions was 1:2 (12 hours and 48 hours; P=.07), the ratio of monocytes was 1:2 (12 hours and 48 hours; P=.08), and the ratio of apoptotic cells was 1:5 (12 hours) and 1:6 (48 hours) (P=.02). Femtosecond laser incisions showed a more sawtooth-like cutting edge than manual incisions. Femtosecond laser-created corneal incisions in human corneas showed no differences in inflammatory cell response but a significantly higher cell death rate than manually performed incisions, indicating an upregulated postoperative wound-healing response. Proprietary or commercial disclosures are listed after the references.

Effect of intracameral carbachol given during cataract surgery on macular thickness

To evaluate the effect of intracameral carbachol on foveal thickness in patients who underwent uneventful cataract surgery. This retrospective study included two groups: the study group patients (group 1, n=47 eyes) had uneventful cataract surgery and received only carbachol 0.01% for miosis; the control group patients (group 2, n=49 eyes) had uneventful cataract surgery without carbachol or any intracameral medication(s). The groups were compared for foveal thickness after cataract surgery. All phacoemulsification plus intraocular lens implantation surgeries were performed under local anesthesia via temporal clear corneal tunnel incisions. Mean values and standard deviations were calculated for preoperative and postoperative visual acuity (VA) and foveal thickness (FT) at 1 and 4weeks. Optical coherence tomography was used for the FT measurements, with the MM6 map program. The patients in the study and control groups had a mean age of 57.78±9.07 and 59.72±8.96, respectively (p=0.355). All eyes had a significant improvement in VA. In the study group, the mean FT at the visits before and 1 and 4weeks after surgery was 216.87±21.06, 228.81±30.52, and 222.94±29.91μm, respectively. For the control group, the mean FT, before and 1 and 4weeks after surgery, was 222.53±17.66, 231.67±23.08, and 225.41±22.59μm, respectively. Intracameral carbachol 0.01% had no effect on foveal thickness in patients who underwent uneventful cataract surgery.

Anterior capsule staining using micronized triamcinolone in the absence of red reflex

We describe a technique to stain the anterior lens capsule with micronized triamcinolone to perform a continuous curvilinear capsulorhexis (CCC) during phacoemulsification in the absence of a red reflex due to vitreous hemorrhage. After a self-sealing clear corneal tunnel incision is performed using a 2.75 mm blade, a dispersive ophthalmic viscosurgical device (OVD) is injected to protect the iridocorneal angle. An air bubble as large as possible is injected into the center of the anterior chamber, and a small amount of micronized triamcinolone is then injected as needed to stain the anterior lens capsule. The OVD injection permits the removal of excessive triamcinolone and protects the corneal endothelium from damage during phacoemulsification. A capsulorhexis forceps is used to perform the CCC. No author has a financial or proprietary interest in any material or method mentioned.

Early changes in clear cornea incision after phacoemulsification: an anterior segment optical coherence tomography study

We aimed to investigate the ultrastructures of clear corneal incisions 24 hours after phacoemulsification using anterior segment optical coherence tomography (AS-OCT). Sixty eyes of 60 patients scheduled for cataract surgery were randomly selected. All eyes underwent the same phacoemulsification procedure carried out by one experienced surgeon. Two-plane temporal clear corneal tunnel incisions were performed. The same types of intraocular lens and implant system were used in all patients. Images of the ultrastructures of the corneal incisions were taken using AS-OCT before and 1 day after surgery. Corneal thickness increased at the incision site after surgery in all eyes (p < 0.001). Epithelial bulla in the incision region was seen in two eyes (3%). Gaping at the internal aspect of the corneal wound was seen in 42 eyes (70%). Eyes with gaping had thicker localized cornea (p = 0.002). Descemet's membrane detachment was seen in 49 eyes (82%); this seemed to be associated with lower preoperative intraocular pressure (p = 0.01). Anterior segment OCT provides sensitive and detailed measurements of the ultrastructures in clear corneal incision.

Spontaneous Corneal Clearance Despite Graft Detachment in Descemet Membrane Endothelial Keratoplasty

To describe spontaneous recovery of corneal transparency in 2 cases with nearly complete graft detachment after Descemet membrane endothelial keratoplasty (DMEK). Case series. In 2 patients with Fuchs endothelial dystrophy, DMEK was performed. Through a 3-mm clear corneal tunnel incision, the recipient Descemet membrane and its endothelium was stripped off from the posterior stroma. A 9.5-mm diameter organ-cultured Descemet roll was inserted into a recipient anterior chamber, positioned onto the posterior stroma, and secured by a complete air filling of the anterior chamber for 45 minutes. At 1 month after uneventful DMEK, both transplanted corneas showed decompensation attributable to subtotal graft detachment. Unexpectedly, corneal transparency improved spontaneously, and at 3 months, both transplanted corneas had a normal pachymetry, despite persistent graft detachment. The patients' visual acuities improved to 20/50 (0.4) and 20/25 (0.8) at 3 months to 20/28 (0.7) and 20/20 (1.0), respectively at 9 months. Corneal clearance in the presence of a detached DMEK graft is not consistent with the current concept of endothelial keratoplasty, which requires an (attached) donor endothelial cell layer at the recipient posterior corneal surface. Endothelial transfer, migration, regeneration, or a combination thereof from either the donor or the recipient may explain the visual recovery. These observations suggest that a review of our approach to endothelial keratoplasty and the management of corneal endothelial disorders may be warranted.

Comparison of the Keratometric Corneal Astigmatic Power after Phacoemulsification: Clear Temporal Corneal Incision versus Superior Scleral Tunnel Incision

Objective. This is prospective randomized control trial to compare the mean keratometric corneal astigmatism diopter power (not surgical induced astigmatism) among preop and one-month and three-month postop phacoemulcification of either a clear temporal corneal incision or a superior scleral tunnel Incision, using only keratometric astigmatic power reading to evaluate the difference between the two cataract surgery incisions. Methods. 120 patients (134 eyes) underwent phacoemulcification were randomly assigned to two groups: Group A, the clear temporal corneal incision group, and Group B, the superior scleral tunnel incision group. SPSS11.5 Software was used for statistical analysis to compare the postsurgical changes of cornea astigmatism on keratometry. Results. The changes of corneal astigmatic diopter in Groups A and B after 3 month postop from keratometric reading were 1.04 + 0.76 and 0.94 + 0.27, respectively (P = .84 >.05), which showed no statistic significance difference. Conclusion. The incision through either temporal clear cornea or superior scleral tunnel in phacoemulcification shows no statistic difference in astigmatism change on keratometry 3-month postop.

Clinical observation of trabeculectomy through reverse clear corneal tunnel incision

目的 探讨反隧道透明角膜切口小梁切除术的效果.方法 青光眼 200 例(200眼).男96例,女104例.年龄25～72岁,平均62.32岁.原发性急性闭角型青光眼172眼(其中急性发作期158眼,慢性期14眼);继发性青光眼28眼.用可调钻石刀以穹隆部为基底在角膜周边血管弓外的透明角膜上做一深500μm,宽4 mm,内口长4～5 mm,外口长3.2 mm的阶梯形角膜隧道切口,随即施行小梁切除术.结果 术后视力,眼压,前房,眼底情况均有改善(P＜0.05);应用此术式视力提高明显,眼压控制稳定且并发症少而轻.结论 经反隧道角膜透明切口实施小梁切除术,操作便利,手术疗效好,稳定。

Preliminary Clinical Results of Descemet Membrane Endothelial Keratoplasty

To describe the preliminary clinical results of selective transplantation of organ cultured, donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5-mm incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the management of corneal endothelial disorders. Nonrandomized clinical study. In 10 patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5-mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0-mm diameter DM roll was harvested from an organ cultured donor corneo-scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes. At one month, six eyes had a best-corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20). At six months, the endothelial cell density averaged 2030 (+/-373) cells/mm(2) (n = 7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure. DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick and nearly complete visual rehabilitation. Because the donor tissue required can be prepared from organ cultured corneo-scleral rims, the procedure may be readily accessible to most corneal surgeons.

DLEK to DSEK to DMEK

Abstract Purpose: To describe the preliminary clinical results of selective transplantation of organ cultured donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5 mm incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the management of corneal endothelial disorders.Design: Non‐randomized clinical trial. Methods: In ten patients with Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5 mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0 mm diameter DM roll was harvested from an organ cultured donor corneo‐scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes. Results: At one month, six eyes had a best corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20) or better. At six months, the endothelial cell density averaged 2030 (± 373) cells/mm2 (n=7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course, that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure. Conclusions: DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick and nearly complete visual rehabilitation. Since the donor tissue required can be prepared from organ cultured corneo‐scleral rims, the procedure may be readily accessable to most corneal surgeons.

Alkali-Induced Corneal Neovascularization Is Independent of CXCR2-Mediated Neutrophil Infiltration

To study the role of infiltrating neutrophils in the development of experimental corneal neovascularization (CNV). CNV was induced by alkali injury in normal C57BL/6 mice, and the kinetics of neutrophil recruitment to the cornea and the CNV was detected by histologic analysis at multiple time points. Neutrophil recruitment to the corneas was inhibited by injection of anti-mouse granulocyte monoclonal antibodies (Ly-6G) or neutralizing anti-mouse CXCR2 antibodies. CNV was compared between the control and the specific antibody-treated mice 2 weeks after alkali injury, as quantified by CD31 immunostaining. Corneal vascular endothelial growth factor (VEGF) expression after injury was determined by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical staining. Many myeloperoxidase-positive neutrophils began to infiltrate the corneas 2 days after injury, but infiltration ceased by 14 days after injury. CNV became evident 7 days after injury, reached a maximal level at 14 days, and decreased thereafter. The mRNA expression of CXCR2 and its ligands, macrophage inflammatory protein 2 (CXCL2/MIP-2), and growth-related protein alpha (CXCL1/KC) increased markedly at 2 days after injury. Injection of either anti-mouse granulocyte monoclonal antibodies (Ly-6G) or neutralizing anti-mouse CXCR2 antibodies markedly, and to a similar extent, inhibited neutrophil recruitment to the cornea, indicating that neutrophil infiltration was mediated primarily by CXCR2. In contrast, these treatments failed to attenuate alkali-induced CNV. VEGF mRNA expression was enhanced 2 days after injury, and VEGF proteins were detected mainly in infiltrating mononuclear cells but not in neutrophils. CXCR2-mediated neutrophil infiltration contributes only marginally to the subsequent development of CNV.

Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery

To evaluate astigmatism outcomes after congenital cataract surgery with intraocular lens implantation using clear corneal or scleral tunnel incisions. We retrospectively reviewed the medical records of 46 children (67 eyes), aged 2 months to 12 years, who had undergone nontraumatic cataract extraction and intraocular lens implantation between 1996 and 2001, using a scleral tunnel incision (group 1), or a clear corneal incision (group 2). Refractive astigmatism was measured at 1 week, 3 months, and 5 months after surgery. Paired t-test was used to compare those variables, and Spearman's correlation was used to determine their relation to patient's age. Mean+/-SD astigmatism at 1 week postoperatively was 3.1+/-2.8 Diopter (D) and 2.1+/-1.7 D in groups 1 and 2, respectively. It significantly reduced to 1.1+/-1.2 D and 0.9+/-1.0 D, respectively, in the two groups at 5 months postoperatively (P<0.007). In both groups patients' age was significantly correlated with 1-week postoperative astigmatism (group 1: r=0.64; P=0.001; group 2: r=-0.58; P=0.003), and with the change in cylinder magnitude between 1 week and 3 months postoperatively (group 1: r=-0.67; P=0.001; group 2: r=0.50; P=0.013). Children who underwent congenital cataract surgery using clear corneal or scleral tunnel incisions showed high postoperative astigmatism at 1 week postoperatively, which spontaneously reduced during 5 months follow-up. Therefore, suture removal is not necessary in those cases.

Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study

To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.