Lamellar Techniques Research Articles

Strategies for Sustainability and Cost Optimization in Corneal Transplantation: From Surgeons' Perspective.

The main purpose of this review is to provide an overview of surgical strategies that can be implemented in keratoplasty to maximize resource utilization and enhance sustainability. To achieve this, we conducted a thorough search of PubMed to identify articles on sustainability and cost-effectiveness in surgical settings, as well as studies comparing the cost-effectiveness of different keratoplasty techniques. Our review shows that both penetrating keratoplasty and lamellar techniques are cost-effective. However, lamellar techniques offer greater long-term sustainability and cost efficiency in addition to improving patient vision. For corneal transplantation surgeries, strategies such as reducing operating room time, properly educating the surgical team, reusing instruments like trephines and punches, using surgical materials economically, and selecting the appropriate surgical technique are recommended to enhance sustainability and reduce costs. The strategies outlined could contribute to more sustainable practices in keratoplasty procedures. In conclusion, although ensuring the economical use of surgical materials is beneficial for improving sustainability and reducing costs during surgery, utmost care should be taken to preserve safety and effectiveness while taking measures to reduce costs, and a balance should be achieved between sustainability and patient safety.

Evolving indications and surgical techniques for corneal transplantation at a tertiary eye care center in southern China

BackgroundThis retrospective study aimed to analyze the evolution of primary indications and surgical techniques for corneal transplantation in Southern China from 2012 to 2021.MethodsThe medical charts of all patients who underwent keratoplasty between January 2012 and December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Southern China were reviewed. We collected and analyzed the primary indications for corneal transplantation and the surgical methods used in each keratoplasty.ResultsThe total number of corneal transplantations was 7,286 during this decade, increasing from 210 cases in 2012 to 1054 cases in 2021. The primary indications for keratoplasty included acquired nontraumatic corneal diseases (56.2%), congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%). Infectious keratitis was the leading indication among all keratoplasties (18.5%), followed by regraft (13.4%). Over the decade, the proportion of infectious keratitis gradually decreased (P = 0.013), while the proportion of regraft increased (P = 0.019). The predominant surgical technique was penetrating keratoplasty (PKP), accounting for 56.7%. However, the number of deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK) significantly increased from 2012 to 2021 (P = 0.007 and P = 0.002).ConclusionsThe annual number of corneal transplants significantly increased from 2012 to 2021. In the past decade, infectious keratitis and regraft have become the leading primary indications for corneal transplantation. Although the use of customized lamellar techniques has dramatically increased, PKP remains the predominant surgical technique for keratoplasty.

Keratoplasty - an Overview of the Methods and their Perioperative Management

Corneal transplantation can be divided into two groups: penetrating and lamellar keratoplasty. Newer minimally invasive procedures have emerged over the years, to improve the visual outcome and reduce complications. This article summarizes the different procedures, their indications and complications, and outlines the pre-, peri- and postoperative management in a clinical setting.Corneal transplantation is the most commonly performed transplantation of donor tissue in modern medicine. In the last years a shift away from penetrating keratoplasty (PK) towards minimally invasive lamellar operative techniques, associated with less complications, can be observed. The Descemet membrane endothelial keratoplasty (DMEK) is used to treat endothelial corneal pathologies and has overtaken the PK to become the most commonly performed form of keratoplasty. Preparation and identification of possible risk-factors are essential preoperative steps to reduce peri- and postoperative complications of keratoplasties. If corneal graft rejection occurs, early and maximum therapy is crucial for graft survival. Laser-assisted techniques offer different advantages in lamellar and penetrating keratoplasty but are not very cost-efficient.

CORNEAL TRANSPLANTATION

Corneal transplantation is an ophthalmic surgery that aims to restore vision in patients with corneal diseases. Advances in transplantation techniques and in the treatment of rejection have improved the results of this procedure, making it more effective and safer. This paper seeks to analyze the latest developments in transplantation techniques and treatments for rejection in corneal transplantation, highlighting not only scientific advances, but also the emotional and social aspects involved in this procedure, providing a comprehensive overview of the latest innovations in the field of corneal transplantation, highlighting improvements in surgical techniques and post-operative treatments, which are helping to transform the lives of thousands of patients around the world. This is a bibliographical review, using qualitative premises, with the PubMed, Scopus, Web of Science and Scielo databases. The health descriptors “corneal transplantation”, “corneal graft rejection” and “penetrating keratoplasty” were used to better refine the research. Corneal transplantation is indicated for various conditions, such as keratoconus, corneal dystrophies, corneal opacities, among others. The most common transplant techniques include complete (penetrating) corneal transplantation, anterior lamellar transplantation and endothelial transplantation (DSAEK/ DMEK). In recent years, there have been significant advances in lamellar transplantation techniques, which allow specific layers of the cornea to be replaced while preserving the healthy layers. This has resulted in better success rates and faster visual recovery compared to penetrating transplantation. Treatment of corneal graft rejection includes the use of topical and systemic corticosteroids, immunosuppressants and anti-inflammatory agents. New approaches, such as biological and immunomodulatory therapies, are also being investigated to improve results in cases of refractory graft rejection. In conclusion, corneal transplantation remains an important option for restoring vision in patients with corneal diseases. Updates in transplantation techniques and advances in the treatment of rejection have improved the results of this procedure, providing patients with a better quality of life and faster and more effective visual recovery.

Multi-lamellar Polychromatic Keratopigmentation: A Novel Approach for Corneal Tattooing

Background Corneal keratopigmentation, commonly known as corneal tattooing, is a cosmetic procedure designed to enhance the visual appearance of non-functional eyes due to congenital, traumatic, or other ocular conditions. Case Presentation This case study presents the outcomes of polychromatic lamellar keratopigmentation, a novel technique employed in three patients. The study assesses cosmetic improvements, patient satisfaction, pigment stability, and procedural complications. Results The study evaluated the outcomes of polychromatic lamellar keratopigmentation in three patients. The procedure achieved an average cosmetic improvement rating of 4.2 on a scale of 1 to 5, reflecting substantial enhancement in corneal appearance. Patients reported a mean satisfaction rating of 9.2 on a scale of 1 to 10, indicating high contentment. Pigment stability over 1 to 3.5 years was excellent, with no complications reported. This underscores the procedure's effectiveness, durability, and safety as a cosmetic enhancement for non-functional eyes. Conclusion The novel polychromatic lamellar keratopigmentation technique is highly effective, with quantifiable improvements in cosmetic appearance, exceptional patient satisfaction, and remarkable pigment stability. This procedure offers a promising and durable option for enhancing the appearance of non-functional eyes.

Новые мезолитические памятники Нижнего Поволжья

The paper publishes materials of the new Mesolithic sites in the Lower Volga region. The research relevance is due to the fact that this period is less studied than the others. The scientific novelty of the study is as follows: after a 30-year break in the Mesolithic studies of this territory, the materials of the 2021 study are presented. The purpose of the paper is to introduce the latest sources on such an important period into scientific circulation. The objectives of the study are to describe and classify the materials, to define the cultural affiliation and to establish their periodization. Methods. The sites of this era in this territory have not been studied since 1993. The sources for the paper are the materials of three new Mesolithic monuments. The Ukubai tract is located in the Krasnoyarsk district of the Astrakhan region. On the territory of the dune, three clusters of stone artifacts remote from each other were planigraphically identified. Neolithic and Eneolithic ceramics were missing. Planographic, typological, statistical and radiocarbon methods were applied. Analysis. The raw material for the tools manufacture was flint of a dark transparent, gray matte and yellow types. The lamellar flake flint-splitting technique was inherent for all three sites. Monuments differ in the number of finds, production waste and blanks, parameters of flakes, a set of tools, and geometric microliths types. Results. Raw material properties are characteristic of the Mesolithic complexes. The average stone age of the finds is also evidenced by the technical and typological features of the stone inventory. The obtained materials can be attributed to the Seroglazovka culture. Some of them belong to the Zhekolgan group and others to the Istay group. The features of the parameters gave an opportunity to pinpoint that the complexes belong to different times. Thus it was possible to highlight the monuments functional features.

Clinical outcomes of Descemet’s stripping endothelial keratoplasty using a manual or automated procedure at Undaan Eye Hospital Surabaya, Indonesia: with one-year follow up

Background: Endothelial keratoplasty (EK) is a selective lamellar corneal transplantation technique that replaces damaged endothelium while preserving the patient's corneal stroma. Donor graft preparation can be done using Descemet stripping endothelial keratoplasty (DSEK) or Descemet stripping automated endothelial keratoplasty (DSAEK). Research on EK in Indonesia is currently underreported, but it is crucial for developing strategies to treat corneal blindness in the future. This study aimed to present visual acuity, graft survival, and complications after DSEK or DSAEK at Undaan Eye Hospital Surabaya. Methods: This study involved 17 eyes, treated with DSEK or DSAEK surgery between 2017 and 2022. Patients with other ocular diseases and incomplete medical records were excluded. Best corrected visual acuity (BCVA) was documented before the surgery, and at 1 day, 1, 3, 6 months, and 1 year after. Data in this study were analyzed using multiple techniques, including Wilcoxon, Kaplan-Meier survival, and bivariate logistic regression analysis. Results: The postoperative mean BCVA significantly increased to 1.36 ± 0.57 logMAR (p=0.012) at 1 day, 1.02 ± 0.62 logMAR (p=0.002) at 1 month, 0.94 ± 0.66 logMAR (p=0.002) at 3 months, 0.72 ± 0.66 logMAR at 6 months (p=0.000), and 0.74 ± 0.74 logMAR (p=0.001) at 1-year compared to preoperative BCVA of 1.84 ± 0.39 logMAR. The graft could survive 100% within 1 day to 6 months and 76% within 1 year after surgery. Bivariate logistic regression showed donor origin had a statistically significant effect with p-value = 0.031 and odds ratio = 1.8, 95% confidence interval (CI) = 1.003 - 3.229. Corneal edema was the most common complication in the early and late postoperative periods. Conclusion: DSEK or DSAEK surgery is safe, effective, and viable. It shows good visual outcomes and becomes the most used EK treatment for corneal endothelial dysfunction.

Corneal transplantation at the beginning of the 21th century

Corneal transplantation (keratoplasty) is necessary when various disorders result in corneal opacities with severe visual loss that cannot be treated conservatively, or the regular structure and curvature of the cornea is distorted, and its function is lost. Among human transplantation, keratoplasty is the most successful surgical procedure. In recent decades, penetrating keratoplasties have been increasingly replaced by lamellar techniques, where only the abnormal layer of the cornea is transplanted. The anterior form is deep anterior lamellar keratoplasty (DALK), recommended mainly for keratoconus. The main forms of posterior lamellar keratoplasty are Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). The indications are bullous keratopathy after cataract surgery with endothelial destruction and Fuchs endothelial dystrophy. Lamellar keratoplasty has several advantages over penetrating surgery. Postoperative visual acuity is better, wound healing, patient rehabilitation are faster and the course of any immune rejection is milder and can be better managed. Orv Hetil. 2023; 164(28): 1087-1093.

Corneal component surgery: Expanding the indications

Despite immense progress in eye banking and corneal transplantation in the past few years in India, we still have a long way to go. The acute shortage of good-quality donor corneal tissues calls for innovative methods to ensure optimum utilization of the available resources including corneal tissues. The recent advances in lamellar surgery techniques have enabled use of one donor corneal tissue in multiple recipients. The authors discuss their experience of using one cornea in three patients with different corneal pathologies. Component corneal surgery is bound to play a key role in combating corneal blindness in India.

Graft Failure after PKP and DMEK: What is the Best Option?

Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Due to the large number of grafts, corneal graft failure has become one of the most common indications for corneal transplantation for immunological and non-immunological reasons (e.g. recurrence of underlying disease, high intraocular pressure, grafted guttae, transmitted HSV or CMV infection). The relatively recently developed lamellar grafting techniques have introduced certain potential complications that may lead to graft failure and require approaches other than penetrating keratoplasty for re-grafting. On the other hand, these new lamellar techniques also offer new possibilities for salvaging failed penetrating grafts, with potential advantages over successive penetrating keratoplasties, such as lower intraoperative risks, faster visual rehabilitation and reduced risk of immune reaction. Today, the patient with good healing who is satisfied with his graft before endothelial decompensation, with low astigmatism and no stromal scars, represents the optimal condition for DMEK after PKP. This can also be combined with phacoemulsification (so-called triple DMEK). Otherwise, a penetrating re-keratoplasty with a larger graft (typically excimer laser repeat PKP 8.5/8.6 mm) is performed to treat edema, scars and irregular astigmatism simultaneously. The medical history carries weight in this decision! Re-DMEK in case of graft failure after DMEK and DSAEK does not require any modification of the standard technique and leads to good visual acuity results if performed quickly. If there is clear stromal scarring after multiple (external) DMEKs, PKP can also be considered to rectify the situation. Otherwise causeless recurrent graft failures must suggest herpetic or CMV endotheliitis and, after PCR analysis of the aqueous humour aspirate, be treated appropriately with medication.

Analysis of 23 Years of Cornea Donor Data From an Eye Bank in Turkey.

We evaluated 23 years of data for cornea donors at the Istanbul Faculty of Medicine Lions Eye Bank. Annual statistics of corneal donors between 1996 and 2019 were reviewed retrospectively. Records for 2008 and previous years were compared with records for 2009 and years thereafter,to assess donor demographics and reasons for discard of corneas. A total of 3849 corneas were obtained from 2018 donors during a 23-year period. Of these, 26 donors (11.2%) were registered, whereas 1792 (88.8%) did not register any decision for donation. There were 210 (5.46%) corneas discarded for positive serology and 291 (7.56%) for unsuitable tissue morphology, and 3348 (86.98%) corneas were determined to be suitable for transplant. For the cause of death in 2009 and subsequent years, the incidence of trauma was lower (P = .001) compared with the years previous to 2009, whereas incidence of cardiac pathology (P = .014) was higher. The number of donors older than 50 years was higher for 2009 and years thereafter, compared with data from earlier years (P = .024). The rate of discarded corneas for unsuitable tissue morphology (P = .004) and total discarded corneas (P = .027) decreased in 2009 and years thereafter. The rate of discarded corneas for HIV was higher after for 2009 and years thereafter (P = .047), whereas the rate of discarded corneas for syphilis was significantly higher for 2015 and years thereafter (P = .001). This study evaluated the most extensive eye bank data in Turkey and found that advances in lamellar surgery techniques and improvements in specular microscopic facilities have expanded the pool for cornealtransplants to include tissues from older donors. Moreover, the incidence rates for HIVpositive and syphilis-positive serology tests in discarded corneas have increased over time.

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques.

PurposeTo report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period.MethodsAnnual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed.ResultsA total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067).ConclusionEndothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.

2D Heterostructured Nanofluidic Channels for Enhanced Desalination Performance of Graphene Oxide Membranes.

The two-dimensional (2D) lamellar membrane assembly technique shows substantial potential for sustainable desalination applications. However, the relatively wide and size-variable channels of 2D membranes in aqueous solution result in inferior salt rejections. Here we show the establishment of nanofluidic heterostructured channels in graphene oxide (GO) membranes by adding g-C3N4 sheets into GO interlamination. Benefiting from the presence of stable and sub-nanometer wide (0.42 nm) GO/g-C3N4 channels, the GO/g-C3N4 membrane exhibits salt rejections of ∼90% with water permeances of above 30 L h-1 m-2 bar-1, while the pure GO membrane only has salt rejections of below 30% accompanied by water permeances of below 4 L h-1 m-2 bar-1. Combining experimental and theoretical investigations, size exclusion has proved to be the dominating mechanism for high rejections, and the ultralow friction water flow along g-C3N4 sheets is responsible for permeation enhancements. Importantly, the GO/g-C3N4 membrane shows promising long-term, antioxidation, and antipressure stability.

Modified surgical technique for lamellar macular holes with lamellar hole-associated epiretinal proliferation (LHEP).

To evaluate the efficacy and safety of lamellar hole-associated epiretinal proliferation embedding technique with modification in the surgical management of degenerative lamellar macular hole (LMH). There is retrospective case series of consecutive eyes who underwent pars plana vitrectomy with LHEP embedding with internal limiting membrane (ILM) inversion technique for degenerative LMH. Primary outcome measure was improvement in foveal contour and central foveal thickness (CFT). Secondary outcome measures were changes in best corrected visual acuity (BCVA), status of outer retinal layers (external limiting membrane-ELM & ellipsoid zone-EZ) and complications. Ten eyes were operated by modified LHEP embedding technique. Mean age was 65.8 ± 5.3years with 1:1 male to female ratio. Simultaneous cataract surgery was done in 70% cases. Mean follow-up duration was 7.9 ± 0.87months. 80% (8/10) eyes had improvement in foveal contour to normal appearance with increase in residual foveal thickness from 90.2 ± 26.83 microns to CFT of 226 ± 35.44 microns at 6months (p = 0.0054). Mean BCVA improved from 0.69 ± 0.19 logMAR to 0.32 ± 0.29 logMAR (p = 0.012). External limiting membrane (ELM) and ellipsoid zone (EZ) defects were present in four eyes (40%) pre-operatively. At the final visit 2 eyes (20%) had persistent defect in both ELM & EZ. None of the eyes progressed to full-thickness macular hole following surgery. The modified surgical technique of LHEP Embedding with ILM inversion is demonstrated to provide satisfactory results with reduced risk of complications for degenerative LMH. Larger and long-term follow-up studies are needed to establish this technique as standard surgical procedure for LMH with LHEP.

ANTERIOR LAMELLAR RECESSION VERSUS TARSAL FRACTURE FOR MANAGEMENT OF RECURRENT CICATRICIAL UPPER LID ENTROPION: A RANDOMIZED COMPARATIVE STUDY

Purpose: to evaluate the efficacy of anterior lamellar recession procedure in the managementof recurrent upper eyelid entropion. Design: randomized prospective comparative study. Methods:all cases will be operated by anterior lamellar recession or tarsal fracture technique. Main outcomeprocedure: anatomical success is defined as the lid margin is stored to its normal position andno skin touch the ocular surface. Results: 20 upper eyelids of 20 patients with recurrent uppereyelid entropion are randomly divided into two groups, and will have either anterior lamellarrecession surgery (group A) or tarsal fracture and marginal rotation surgery (group B). In group A, anatomical success was achieved in 70 % of cases and 3 cases (30%) had recurrence.Conclusion: this study shows that recurrent upper eyelid entropion can be managed efficientlywith anterior lamellar recession technique.

Femtosecond laser-assisted big bubble for deep anterior lamellar keratoplasty.

To assess the utility of a femtosecond laser-assisted stromal channel to assist the creation of a big bubble (BB) for deep anterior lamellar keratoplasty (DALK) surgery in cadaveric corneas. L V Prasad Eye Institute, Hyderabad, India. Experimental study. An attempt to create a BB was made on 10 donor pairs of human cadaveric corneoscleral tissues. The 20 corneas were split into 2 groups: Group A underwent femtosecond laser pretreatment and Group B had conventional manual deep lamellar technique. Laser pretreatment was performed using the VisuMax femtosecond laser system to create a stromal channel using the intracorneal ring segment treatment module for direct insertion of the 27-gauge air cannula for pneumodissection at a predetermined depth. Of the 20 corneas studied, type 1 BB was achieved in 9 of 10 corneas in Group A and in 7 of 10 corneas in Group B. One cornea from Group A had a combined type 1 and 2 BB, whereas no BB was achieved in 1 cornea. Creation of an intrastromal channel using a femtosecond laser at a predetermined depth seemed to be a promising option to increase the chances of achieving a BB when compared with the conventional air injection technique of BB DALK.

Comparison of Corneal Densitometry Between Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Keratoconus Patients.

Our aim was to compare corneal densitometry values in keratoconic eyes undergoing deep anterior lamellar keratoplasty with the "big bubble" and manual lamellar dissection techniques, as well as penetrating keratoplasty. This retrospective study evaluated the postoperative outcomes of 31 eyes treated with big bubble-deep anterior lamellar keratoplasty, 23 eyes with manual lamellar dissectiondeep anterior lamellar keratoplasty, and 37 eyes with penetrating keratoplasty. Corneal densitometry, best corrected visual acuity, and other corneal tomographic parameters were recorded at 1, 6, 12, and 24 months postoperatively. The groups were compared with respect to the outcomes. There were no significant differences between the groups with respect to the anterior, central, and total corneal densitometry values at 0 to 2 mm and 2 to 6 mm. At 1 month postoperatively, the densitometric value in the posterior corneal layer of the 0- to 2-mm and 2- and 6-mm corneal zones was higher in the manual lamellar dissection-deep anterior lamellar keratoplasty group than in the big bubble-deep anterior lamellar keratoplasty and penetrating keratoplasty groups (P = .001). At 6, 12, and 24 months, the manual lamellar dissectiondeep anterior lamellar keratoplasty and penetrating keratoplasty groups had similar values in both zones in the posterior layer. The difference between manual lamellar dissection-deep anterior lamellar keratoplasty and big bubble-deep anterior lamellar keratoplasty in both zones in the posterior layer was statistically significant at 6, 12, and 24 months postoperatively (P < .05). The best corrected visual acuity of big bubble-deep anterior lamellar kerat oplasty and penetrating keratoplasty groups was better than that of the manual lamellar dissection-deep anterior lamellar keratoplasty group (P = .047). Corneal densitometry values may vary depending on the type of keratoplasty used in keratoconus patients. Higher densitometry values may affect visual quality in keratoplasty patients by decreasing or filtering the light that reaches the retina.

Modified deep anterior lamellar dissection for corneal opacity during vitrectomy: case reports

BackgroundTo introduce a modified deep anterior lamellar dissection technique to improve visibility during surgery for vitreoretinal diseases with coexisting corneal opacity.Case presentationTwo patients with retinal detachment and coexisting corneal blood staining or corneal decompensation underwent modified deep anterior lamellar dissections followed by vitrectomy. The modified deep anterior lamellar dissection techniques, unlike the dissection and removal of corneal lamellar in a typical deep anterior lamellar keratoplasty, included the creation and preservation of a deep lamellar corneal flap, the retroillumination to visualize and easily remove the remaining opaque stroma on the Descemet membrane, and the big air bubble technique in the eye with endothelial decompensation. The patient’s own cornea flap was sutured back after vitrectomy was done. The modified dissection techniques provided adequate fundus view during vitrectomy while removing as less corneal tissue as possible and decreasing the surgical complications and the requirement of a fresh cornea. Postoperatively, in case 1, the corneal blood staining was gradually absorbed and the vision improved from light perception to counting fingers. In case 2, even though the cornea remained cloudy and the vision was poor, the cornea endothelial decompensation was stable and asymptomatic. Both retinas were attached after silicone oil removal at 6-month follow-up.ConclusionsThis modified and limited deep anterior lamellar corneal dissection procedure appears to be a useful alternative to penetrating keratoplasty, ophthalmic endoscope and temporary keratoprosthesis during the vitrectomy with coexisting corneal opacity.

Optimizing outcomes for keratoplasty in ectatic corneal disease.

Advanced keratectasia often requires corneal transplantation for restoration of vision. This review discusses the surgical approach suitable for these cases including significant updates in the current literature. With greater understanding of ectatic corneal disease and its associated operative challenges, several modifications in the surgical approach have been developed. Identified predictive factors for successful pneumatic dissection and intraoperative complications have informed surgical planning and decision-making. In the setting of failed pneumatic dissection, sequential use of alternative lamellar dissection techniques is a reasonable surgical strategy. Surgical refinements to optimize visual outcomes and postoperative interventions to correct residual refractive errors have improved visual rehabilitation after keratoplasty. With evidence of its undisputed advantages, DALK has been widely recognized as the primary surgical option for ectatic corneal disease.

Cataract surgery in corneal transplantation.

Corneal diseases are often associated with lens opacity. The present article reviews the recent advances in the management of cataract and corneal transplant. Thanks to the development of lamellar transplant techniques and the evolution of cataract surgery, we now have several strategies to address corneal diseases and cataract including 'lamellar triple procedure'. Numerous precautions have been identified to have a successful surgery with good visual recovery. Corneal diseases associated with cataract can be successfully managed using separate or combined surgical procedures, as appropriate. In most cases the intraocular lens power can be calculated with a predictable outcome.