Showing posts with label Cornea and External diseases. Show all posts
Showing posts with label Cornea and External diseases. Show all posts
Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia
SAAD ALHARBI
Purpose: The objective of this study is to compare the recurrence and complication rates of surgical treatment and interferon treatment for OSSN.
Participants: Ninety-eight patients with OSSN, 49 of whom were treated with interferon (IFN) a2b therapy and 49 of whom were treated with surgical intervention.
Methods: Patients with OSSN were treated with surgery versus IFNa2b therapy, either in topical or injection form. Median follow-up after lesion resolution was 21 months (range, 0e173 months) for the IFNa2b group and 24 months (range, 0.9e108 months) for the surgery group.
Main Outcome Measures: The primary outcome measure for the study was the rate of recurrence of OSSN in each of the treatment groups. 
Results: Mean patient age and sex were similar between the groups. There was a trend toward higher clinical American Joint Committee on Cancer tumor grade in the IFNa2b group. Despite this, the number of recurrences was equal at 3 per group. The 1-year recurrence rate was 5% in the surgery group versus 3%in the IFNa2b group (P ¼ 0.80). There was no statistically significant difference in the recurrence rate between the surgically and medically treated groups. Nonlimbal location was a risk factor for recurrence (hazard ratio, 8.96) in the entire study population. In patients who were treated successfully, the side effects of the 2 treatments were similar, with mild discomfort seen in the majority of patients in both groups. There was no limbal stem cell deficiency, symblepharon, or diplopia noted in either group. Two patients were excluded from the IFNa2b group because of intolerance to the medication.
Conclusions: No difference in the recurrence rate of OSSN was found between surgical versus IFNa2b therapy.


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Ultra-thin DSAEK
SAAD ALHARBI
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Excision Of Limbal Dermoid
SAAD ALHARBI
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Fibrin Glue (TISSEEL) Preparation
SAAD ALHARBI
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Intralase Enabled Keratoplasty
SAAD ALHARBI
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PKP+Aniridia Scleral Fixated IOL
SAAD ALHARBI
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Management of post-keratoplasty astigmatism
SAAD ALHARBI





                Post-keratoplasty astigmatismremains a challenge for corneorefractive surgeons.While maintaining a healthy graft is the most crucial issue in keratoplasty procedures, astigmatismis a limiting factor in the visual rehabilitation of otherwise successful corneal grafts. The management of post-keratoplasty astigmatism takes place at 2 stages: when sutures are still present at the graft–host junction and when all sutures have been removed. Excessive suture-in post-keratoplasty astigmatism is usually managed by selective suture manipulation, ie, suture adjustment and/or suture removal along the steep meridian of astigmatism. A small amount of suture-out post-keratoplasty astigmatism can be managed by spectacles. Higher magnitudes of astigmatism can be addressed by contact lenses or surgical intervention, such as relaxing and compressing procedures. Laser lamellar refractive surgery can also be used to manage post-keratoplasty astigmatism, and toric phakic intraocular lenses have recently been recommended. In this review, we discuss the etiology and management of post-keratoplasty astigmatism and provide recommendations and tips to minimize it.


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Lamellar Keratoplasty + Phaco+PC IOL
SAAD ALHARBI

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Nichamin Age & Pachymetry-Adjusted Arcuate Astigmatic Nomogram
SAAD ALHARBI
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Corneal Ring Surgical Technique
SAAD ALHARBI
Animated instruction
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Surgical Technique
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Iris Fixated PC IOL + DSAEK
SAAD ALHARBI
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Descemet's stripping automated endothelial keratoplasty (DSAEK)
SAAD ALHARBI
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Small aperture corneal inlay for the correction of presbyopia
SAAD ALHARBI
PURPOSE: To report the 3-year postoperative safety and efficacy outcomes of the Acufocus corneal inlay.
DESIGN: Prospective nonrandomized noncomparative cohort study.
METHODS: The corneal inlay was implanted in the nondominant eye of naturally emmetropic presbyopic patients. Refraction, uncorrected near (UNVA), intermediate (UIVA), and distance (UDVA) visual acuities; corrected distance visual acuity(CDVA); contrast sensitivity; visual fields; subjective patient satisfaction and symptoms; and operative and postoperative adverse events and complications were evaluated.
RESULTS: The study enrolled 32 patients. The mean UNVA improved from Jaeger (J) 6 preoperatively to J1 at 3 years and the mean UIVA, from 20/40 to 20/25, respectively. At 3 years, 97% of eyes had a UNVA of J3 or better and 91% had a UIVA of 20/32 or better. The mean UDVA was 20/20, with all eyes achieving 20/32 or better. Nine eyes (28.3%) lost 1 line of CDVA, 1 eye (3.1%) lost more than 2 lines (3.8 lines), and 3 eyes (9.3%) gained 1 line. No inlay was explanted, and no inflammatory
reactions were observed. At 3 years, 15.6% of patients reported severe night-vision problems and 6.3% (versus 87.5% preoperatively) reported being dependent on reading glasses.
CONCLUSIONS: These 3-year results support the safety and efficacy of the corneal inlay to correct presbyopia in naturally emmetropic presbyopic patients. However, despite a significant gain in UNVA and UIVA, 28.3% of patients lost 1 line of CDVA.

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Descemet’s Membrane Endothelial Keratoplasty (DMEK)
SAAD ALHARBI
Purpose: To report 1-year outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) performed at 2 centers.
Design: Prospective, consecutive, interventional series.
Participants: Patients with Fuchs’ endothelial dystrophy, pseudophakic bullous keratoplasty, or failed previous graft (n=136 eyes).
Intervention: The diseased central 7 mm of Descemet’s membrane (DM) was stripped from the recipient cornea and replaced with healthy DM and endothelium stripped from donor corneas through a 2.8-mm corneal incision. Descemet’s membrane endothelial keratoplasty was performed alone (n=110) or combined with either phacoemulsification and intraocular lens implantation (n=23) or pars plana vitrectomy (n =3).
Main Outcome Measures: Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density.
Results: Excluding eyes with pre-existing ocular comorbidities or those lost to follow-up, mean BSCVA at 1 year was 0.07 logarithm minimum angle of resolution (logMAR) units (20/24;range, 20/15–20/40; n=81), improving from 0.51 logMAR (20/65; range, 20/20–counting fingers); 41% of the patients achieved a BSCVA of 20/20 or better, 80% could be corrected to 20/25 or better, and 98% achieved 20/30 or better vision. A refractive hyperopic shift of +0.24+-1.01 diopters (D; range, –1.50 to 2.25 D) was found at 1 year, but it was not statistically significant (P=0.08). Also, there was no significant change in the preoperative astigmatism (P=0.17). The
endothelial cell loss at 1 year was 36+-20% (n=94; range, 13%–88%), with most of the loss being observed during the first 3 months after surgery: 31+-18% (range, 3%–77%). The DMEK graft creation could not be successfully completed in 6 cases (4.2%). All these unsuccessful attempts were among the initial 40 cases. Intracameral air was used to fix graft detachments, which usually were partial and peripheral, in 62% of the cases. Eleven grafts (8%) demonstrated primary failure and 1 eye (0.7%) had secondary failure resulting from endothelial rejection. Episodes of immunologic rejection were documented in 7 eyes (5.1%) during the first year of follow-up.
Conclusions: Descemet’s membrane endothelial keratoplasty had better visual acuity results in the first year after surgery than typically reported for other endothelial keratoplasty techniques, such as Descemet’s stripping automated endothelial keratoplasty, while having less refractive changes and similar endothelial cell counts but a higher rebubbling rate.

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Treatments for Corneal Neovascularization: A Review
SAAD ALHARBI
Corneal neovascularization (CNV) may be a physiological response to various stimuli, but a chronic and persistent upregulation of neoangiogenesis can result in pathological CNV. Pathological blood vessels are immature and lack structural integrity, predisposing the cornea to lipid exudation, inflammation, and scarring. CNV can therefore become a potentially blinding condition. In this review, we frame CNV in an epidemiological perspective, consider risk factors for CNV, provide an overview of CNV pathogenesis, and consider the impact of CNV on corneal transplantation. We consider treatments that are of largely historical interest, before reviewing contemporary medical and surgical treatments.Within medical treatments, we report on steroids, nonsteroidal anti-inflammatory agents, antivascular endothelial growth factor agents, and cyclosporine. Within surgical treatments, we report on the use of lasers, photodynamic therapy, superficial keratectomy, and diathermy/cautery-based treatments.
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Horizons in Therapy for Corneal Angiogenesis
SAAD ALHARBI
Corneal neovascularization can lead to a devastating disease process that involves the breakdown of the limbal barrier and the formation of blood vessels in the cornea, leading to severe visual impairment. This review discusses the delicate balance between antiangiogenic and angiogenic factors that govern the antiangiogenic privilege of the cornea. Current treatment methods, clinical trials, and future prospects in the management of corneal neovascularization also are discussed.


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