scholarly journals Malapposition of Graft-host Interface after Keratoplasty: an Optical Coherence Tomography Study

2018 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu

Abstract Background: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each wound malapposition affected post-keratoplasty visual outcomes. In this study, reviewing our postsurgical keratoconic patients using anterior segment optical coherence tomography (AS-OCT) to evaluate the correlation between characteristics of the graft-host interface (GHI) and visual outcomes was aimed. Methods: Correlations between characteristics of GHI and the postsurgical visual outcomes, including logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC), and keratometric astigmatism, were evaluated of 45 eyes (patients). Results: The graft-host touch (GHT) varied with different alignment patterns. LogMAR BCVA correlated positively with GHT (r=0.32, P=0.030) and junctional graft thickness (Tg) (r=0.49, P=0.001). SE had positive correlation with frequency of step [F (step)] (r=0.46, P=0.001), graft step [F (graft step)] (r=0.40, P=0.028), total prevalence of malapposition proportion (Pm) (r=0.35, P=0.018), size of malapposition (Sm) (r=0.31, P=0.037), Tg (r=0.03, P=0.022), disparity between junctional graft and host thickness (|Tg-Th|) (r=0.40, P=0.007), and correlated negatively with GHT (r=-0.34, P=0.021). Similar results were acquired in DS. Keratometric astigmatism was found to correlate positively with Sm (r=0.30, P=0.047). Conclusion: In keratoconic eyes, corneal keratometric astigmatism increased by 0.017 with Sm. LogMAR BCVA increased by 0.001 with both GHT and Tg. Investigation of the visions for keratoconus patients. Our study might have potential reference value for future technological promotion.

2019 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the correlations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Correlations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)] were evaluated for 45 patients (one eye each). Results: 22 post-PK and 23 post-DALK keratoconic patients were enrolled. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased by 6.851, 5.428 and 5.164 times for every 1% increase in: F (step) [b=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [b=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [b=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased by 0.031 times for every 1-μm increment of |Tg-Th| [b=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased by 0.001 times for every 1-μm increment of both GHT [b=0.001; 95% CI=0-0.002; P=0.030]. and Tg [b=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased by 0.017 times for 1-μm increment of Sm [b=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.


2021 ◽  
pp. 283-287
Author(s):  
Jo Moriya ◽  
Shinichi Sakamoto ◽  
Satoru Inoda ◽  
Hidenori Takahashi ◽  
Hidetoshi Kawashima

Accidental intraocular lens (IOL) implantation into the corneal stroma is a rare clinical entity that can occur during the wound-assisted technique. In this report, we describe a case of an 81-year-old man who underwent cataract surgery in which the IOL was implanted into the corneal stroma with the wound-assisted technique, and we present changes in anterior segment optical coherence tomography. The IOL was removed and reinserted after widening the incision. Air tamponade was created by intracameral injection. An anterior chamber tap was performed 10 h later to reduce increased intraocular pressure. Interlayer separation of the corneal stroma was confirmed 30 min postoperatively but was corrected 4 days later. The patient’s best-corrected visual acuity (BCVA) was logMAR 0.30, and he had been diagnosed with age-related macular degeneration before surgery. Although the opacity of the corneal stroma persisted, BCVA improved to logMAR 0. When using the wound-assisted technique for IOL insertion, surgeons should take care not to implant the IOL into the corneal stroma.


2011 ◽  
Vol 36 (9) ◽  
pp. 782-786 ◽  
Author(s):  
Ahmad Kheirkhah ◽  
Mohsen Adelpour ◽  
Mojgan Nikdel ◽  
Reza Ghaffari ◽  
Hamed Ghassemi ◽  
...  

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1864
Author(s):  
María García-Zamora ◽  
Ignacio Flores-Moreno ◽  
Jorge Ruiz-Medrano ◽  
Rocío Vega-González ◽  
Mariluz Puertas ◽  
...  

Purpose: To study clinical features in patients with ridge-shaped macula (RSM) compared with those with dome-shaped macula (DSM) having been previously classified by the number of swept-source optical coherence tomography (SS-OCT) radial scans affected. Methods: Retrospective observational study including 49 highly myopic eyes from 31 patients who underwent SS-OCT. DSM eyes were defined as those that showed a complete round inward convexity in all their axes, presenting an inward convexity ≥50 µm in the 12-line radial OCT scans. Eyes that did not meet this criterion and had at least one flat radial scan were grouped into the RSM group, defined as a macular inward convexity in some meridians across the fovea, whereas the opposite perpendicularly oriented meridians were flat. Age, spherical equivalent, axial length (AL), and best-corrected visual acuity (BCVA) were collected. Height of the bulge, scleral and choroidal thicknesses, Bruch´s membrane defects, and presence of perforating scleral vessels were recorded. Results: Thirty-seven (75.5%) eyes were classified into the RSM group and 12 (24.5%) into the DSM group. Twenty-six (53.0%) eyes showed macular elevation only in the horizontal direction. Mean AL showed statistically significant differences (28.8 ± 2.7 vs. 30.5 ± 1.5 mm in the RMS vs. DSM group, respectively) and the presence of Bruch´s membrane defects was more frequently seen in DSM (p < 0.001). Mean age, spherical equivalent, BCVA, height of the inward convexity, retinal foveal thickness, foveal scleral thickness, subfoveal choroidal thickness, and the presence of perforating scleral vessels did not show significant differences between groups. Conclusion: This study shows the reliability of using the 12 equal radial OCT scans as an objective method to define and differentiate DSM versus RSM. Patients with RSM showed differences in AL compared with those with DSM, being longer in DSM, and regarding the presence of Bruch´s membrane defects, being more common in DSM. This may contribute to identifying those patients that, in daily clinical practice, have a higher risk of developing complications due to their myopia.


2020 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)]. Results: We enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [β=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [β=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [β=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased averagely by 0.31 diopter per 10-μm increment in |Tg-Th| [β=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-μm increment in both GHT [β=0.001; 95% CI=0-0.002; P=0.030]. and Tg [β=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased on average by 0.17 diopter per 10-μm increment in Sm [β=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.


2019 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg),junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)]. Results: We enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [β=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [β=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [β=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased averagely by 0.31 diopter per 10-μm increment in |Tg-Th| [β=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-μm increment in both GHT [β=0.001; 95% CI=0-0.002; P=0.030]. and Tg [β=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased on average by 0.17 diopter per 10-μm increment in Sm [β=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.


2018 ◽  
Vol 1 ◽  
pp. 3
Author(s):  
Joshua S Agranat ◽  
Yoshihiro Yonekawa

Iris pigment epithelial (IPE) cysts are a subset of iris cysts that arise from the IPE. They are spontaneously erupting epithelial-lined cavities that are found in various anatomic locations of the iris, including the iris pupillary margin, midzone, periphery, and free floating in the vitreous or anterior chamber. We report the case of an asymptomatic 13-year-old boy with an incidental finding of a dislodged anterior chamber cyst diagnosed on routine examination. Modern multimodal image analysis of the cyst including anterior segment optical coherence tomography and ultrasound biomicroscopy (UBM) was utilized to characterize the microstructural anatomy of the lesion. The patient was managed conservatively without complications. Cysts of the IPE typically do not affect vision or ocular health and can be monitored and observed after ascertaining no associated malignancy. Initial diagnostic investigation can include UBM and anterior segment optical coherence tomography. Intervention should be reserved only for cases where the cyst growth leads to obstruction of the visual axis and/or other secondary complications.


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