50 results on '"James Myerscough"'
Search Results
2. P-14 Factors associated with the disparity between manifest refractive cylinder and keratometric astigmatism in keratoconic eyes
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James Myerscough, Harry Roberts, Elizabeth Law, Max Davidson, Jesse Panhtagani, Mohamed Elkadim, and Philip Buckhurst
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Ophthalmology ,RE1-994 - Published
- 2023
- Full Text
- View/download PDF
3. P-17 An innovative technique for practising peeling of donor descemet’s membrane for descemet’s membrane endothelial keratoplasty
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James Myerscough, Harry Roberts, Muhammad Haseeb, and Shakeel Ahmad
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Ophthalmology ,RE1-994 - Published
- 2023
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- View/download PDF
4. P-18 ‘No Nonsense’ DMEK: Safety and efficacy of postureless DMEK with deferred post-operative review until one week
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Mark R Wilkins, James Myerscough, Harry Roberts, Max Davidson, Ahmad Shakeel, and Francis Saunders
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Ophthalmology ,RE1-994 - Published
- 2023
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- View/download PDF
5. Treatments for Ocular Diseases in Pregnancy and Breastfeeding: A Narrative Review
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Giuseppe Demarinis, Filippo Tatti, Andrea Taloni, Antonio Valentino Giugliano, Jesse Panthagani, James Myerscough, Enrico Peiretti, and Giuseppe Giannaccare
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pregnancy ,eye ,breastfeeding ,eye drop ,ocular diseases ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Pregnancy is a medical condition in which the physiological changes in the maternal body and the potential impact on the developing fetus require a cautious approach in terms of drug administration. Individual treatment, a thorough assessment of the extent of the disease, and a broad knowledge of the therapeutic options and different routes of administration of ophthalmic drugs are essential to ensure the best possible results while minimizing risks. Although there are currently several routes of administration of drugs for the treatment of eye diseases, even with topical administration, there is a certain amount of systemic absorption that must be taken into account. Despite continuous developments and advances in ophthalmic drugs, no updated data are available on their safety profile in these contexts. The purpose of this review is both to summarize the current information on the safety of ophthalmic treatments during pregnancy and lactation and to provide a practical guide to the ophthalmologist for the treatment of eye diseases while minimizing harm to the developing fetus and addressing maternal health needs.
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- 2023
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6. Anterior segment optical coherence tomography (AS -OCT) as a useful tool to identify retained lens fragments in the anterior chamber
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James Myerscough, Chrishan Duminda Gunasekera, Harry W Roberts, and Haseeb Akram
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medicine.medical_specialty ,genetic structures ,medicine.diagnostic_test ,business.industry ,Anterior Chamber ,medicine.medical_treatment ,General Medicine ,Phacoemulsification ,eye diseases ,medicine.anatomical_structure ,Optical coherence tomography ,Anterior Eye Segment ,Lens (anatomy) ,Ophthalmology ,Lens, Crystalline ,medicine ,Humans ,sense organs ,business ,Pseudophakic bullous keratopathy ,Tomography, Optical Coherence - Abstract
We report a case of pseudophakic bullous keratopathy (PBK) in which clinical examination failed to identify a retained lens fragment (RLF) which was subsequently diagnosed using anterior segment optical coherence tomography (AS-OCT) A 79-year-old man underwent routine phacoemulsification in the
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- 2023
7. Selective Laser Trabeculoplasty for Steroid-Induced Ocular Hypertension following Endothelial Keratoplasty
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Max Davidson, Eran Berkowitz, Harry Roberts, Ahmed Wanas, and James Myerscough
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Lasers ,Visual Acuity ,Glaucoma ,Trabeculectomy ,Sensory Systems ,Corneal Transplantation ,Cellular and Molecular Neuroscience ,Ophthalmology ,Treatment Outcome ,Humans ,Ocular Hypertension ,Steroids ,Laser Therapy ,Antihypertensive Agents ,Descemet Stripping Endothelial Keratoplasty ,Intraocular Pressure ,Retrospective Studies - Published
- 2022
8. P-14 Factors associated with the disparity between manifest refractive cylinder and keratometric astigmatism in keratoconic eyes
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Jesse Panhtagani, Elizabeth Law, Max Davidson, Mohamed Elkadim, Harry Roberts, Philip Buckhurst, and James Myerscough
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- 2023
9. P-18 ‘No Nonsense’ DMEK: Safety and efficacy of postureless DMEK with deferred post-operative review until one week
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Ahmad Shakeel, Harry Roberts, Max Davidson, Francis Saunders, James Myerscough, and Mark R Wilkins
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- 2023
10. High Astigmatism After Conventional Diameter Deep Anterior Lamellar Keratoplasty in Keratoconus Can Be Successfully Managed With Repeat Wide Diameter Deep Anterior Lamellar Keratoplasty
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Jesse Panthagani, Elizabeth M. Law, Chimwemwe Chipeta, Harry Roberts, and James Myerscough
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Ophthalmology - Published
- 2023
11. P-17 An innovative technique for practising peeling of donor descemet’s membrane for descemet’s membrane endothelial keratoplasty
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Shakeel Ahmad, James Myerscough, Muhammad Haseeb, and Harry Roberts
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- 2023
12. Safety and clinical outcomes of omitting same and next day review after DMEK performed with an inferior peripheral iridotomy
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Harry W. Roberts, Haseeb Akram, Max Davidson, and James Myerscough
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Ophthalmology - Published
- 2023
13. Long-Term Outcomes of Two-Piece Mushroom Keratoplasty for Traumatic Corneal Scars
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Massimo Busin, Rossella Spena, Federica Fabbri, Angeli Christy Yu, James Myerscough, Riccardo Dondi, Cristina Bovone, and Fiorella Fusco
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medicine.medical_specialty ,Visual acuity ,genetic structures ,Visual Acuity ,Socio-culturale ,Glaucoma ,Astigmatism ,Refraction, Ocular ,Corneal Transplantation ,Penetrating ,Ocular ,Ophthalmology ,medicine ,Long term outcomes ,Humans ,Endothelium ,Dioptre ,Corneal Scar ,business.industry ,Endothelium, Corneal ,Corneal ,Postoperative complication ,medicine.disease ,eye diseases ,Endothelial cell density ,Refraction ,Treatment Outcome ,Keratoplasty ,medicine.symptom ,business ,Keratoplasty, Penetrating ,Corneal Injuries - Abstract
PURPOSE To report the outcomes of two-piece microkeratome-assisted MK for eyes with full-thickness traumatic corneal scars and otherwise functional endothelium following corneal penetrating injury. DESIGN Interventional case series METHODS: : In this single-center study, 41 consecutive eyes with traumatic corneal scars that underwent two-piece microkeratome-assisted mushroom keratoplasty were evaluated. The two-piece mushroom graft consisted of an anterior lamella of 9-mm diameter and a posterior lamella of 6-mm diameter. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density and postoperative complication rates. RESULTS Of the 41 total cases, 38 eyes (93%) reached Snellen vision ≥20/100, 36 (88%) reached ≥20/60, 29 (71%) reached ≥20/40 and 13 (32%) reached ≥20/25 2 years following MK. Excluding eyes with vision-impairing comorbidities, baseline logMAR BSCVA (1.41±0.73) significantly improved annually during the first 2 years (p < 0.001) reaching 0.16±0.13 at year 2 which subsequently remained stable up to 10 years (p = 0.626). RA exceeded 4.5 diopters in 2 cases (5%) after wound revision for high-degree astigmatism in 5 cases. Endothelial cell loss was 35.1% at 1 year with an annual decline of 2.9% over 10 years. Elevation in IOP was observed postoperatively in 7 eyes of which 6 had pre-existing glaucoma. The 10-year cumulative risk for graft rejection and failure was 8.5% and 10% respectively. CONCLUSION Two-piece microkeratome-assisted MK for traumatic corneal scars can allow excellent visual rehabilitation with relatively stable ECL and low rates of immunologic rejection and graft failure.
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- 2022
14. Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis
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Harry W. Roberts, Max Davidson, Caroline Thaung, and James Myerscough
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Corneal Transplantation ,Keratitis ,Ophthalmology ,Corneal Perforation ,Visual Acuity ,Humans ,Female ,Eye Infections, Bacterial ,Keratoplasty, Penetrating - Abstract
The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty.The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique.The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9.This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty.
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- 2021
15. Factors predictive of cystoid macular oedema following endothelial keratoplasty: a single-centre review of 2233 cases
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Michael Mimouni, Angeli Christy Yu, Matteo Mandrioli, Harry W Roberts, Massimo Busin, James Myerscough, Luca Furiosi, and Giuseppe Giannaccare
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0301 basic medicine ,medicine.medical_specialty ,Postoperative cystoid macular oedema ,Receiver operating characteristic ,business.industry ,Incidence (epidemiology) ,Curve analysis ,medicine.disease ,Sensory Systems ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Ophthalmology ,Single centre ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Diabetes mellitus ,Cornea ,Cystoid macular oedema ,030221 ophthalmology & optometry ,Medicine ,business - Abstract
AimsTo describe the incidence of postoperative cystoid macular oedema (CMO) after endothelial keratoplasty (EK) and to identify its contributory risk factors.Methods2233 patients undergoing EK at Ospedali Privati Forlì ‘Villa Igea’, between January 2005 to October 2018 for Descemet stripping automated endothelial keratoplasty (DSAEK) and June 2014 to August 2018 for Descemet membrane endothelial keratoplasty (DMEK) with a minimum follow-up of 18 months were evaluated. Univariate and multivariate analyses were conducted to identify and quantify contributory risk factors. Receiver operating characteristic (ROC) curve analysis were performed to determine ideal cut-off points of continuous variables.ResultsCMO was identified in 2.82% (n=63) of the cases. CMO occurred in 2.36% of DSAEK eyes and in 5.56% of DMEK eyes (p=0.001). Average onset of CMO was 4.27±6.63 months (range: 1–34 months) postoperatively. Compared with those who did not develop CMO, a higher proportion of patients in the CMO group had diabetes (24.2% vs 9.8%, p67 years (OR=2.35, 95% CI: 1.30 to 4.26, p=0.005) were more likely to develop CMO. There were no other significant differences between the groups.ConclusionsOlder age (>67 years), diabetes mellitus and DMEK have been identified as independent risk factors for postoperative CMO following EK. Close observation is necessary during the first postoperative year after EK, particularly in patients with risk factors.
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- 2021
16. COVID-19 Vaccination Induced Corneal Graft Rejection Does Not Exist: Results of a Large Multi-country Population Based Study
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Harry Roberts, Mark Wilkins, Mohsan Malik, Melody Langroudi, James Myerscough, Marco Pellegrini, Angeli Christy Yu, and Massimo Busin
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PURPOSE: The aim of the study was to present the rates of corneal transplant rejection from 2018 to 2022 at both Moorfields Eye Hospital UK, and Ospedali Privati Forli (OPF) “Villa Igea”, Italy and evaluate the purported association between COVID-19 vaccination and rejection. METHODS: We performed a retrospective review of rejection cases presenting to the two units. Monthly rates were correlated against regional vaccination program rates. At OPF, conditional Poisson regression model was employed to estimate the incidence risk ratio (IRR) of graft rejection following COVID-19 vaccination risk period compared with the control period. RESULTS: Between January 2018 and March 2022, there were 471 (Moorfields), 95 (OPF) episodes of rejection. From the start of vaccination programme in the UK in late January 2021, the median number of graft rejections per month at Moorfields was 6 (range: 5 – 9), which was not significantly different to post-lockdown, pre-vaccination programme (March 2020 – January 2021), p=0.367. At OPF, the median rates of rejection before and after initiation of the vaccination program were not significantly different (p=0.124). No significant increase in incidence rate of rejection in the risk period following COVID-19 vaccination was found (IRR=0.53, p=0.71). CONCLUSION: No notable increase in rates of transplant rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID-19 vaccination and corneal graft rejection highlighted in several case reports may not represent a causative association
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- 2022
17. A lack of an association between COVID-19 vaccination and corneal graft rejection: results of a large multi-country population based study
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Harry W. Roberts, Mark R. Wilkins, Mohsan Malik, Melody Talachi-Langroudi, James Myerscough, Marco Pellegrini, Angeli Christy Yu, and Massimo Busin
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Ophthalmology - Abstract
The aim of the study was to present the rates of corneal transplant rejection from 2018 to 2022 at both Moorfields Eye Hospital UK, and Ospedali Privati Forli (OPF) "Villa Igea", Italy and evaluate the purported association between COVID-19 vaccination and rejection.We performed a retrospective review of rejection cases presenting to the two units. Monthly rates were correlated against regional vaccination programme rates. At OPF, conditional Poisson regression model was employed to estimate the incidence risk ratio (IRR) of graft rejection following COVID-19 vaccination risk period compared with the control period.Between January 2018 and March 2022, there were 471 (Moorfields), 95 (OPF) episodes of rejection. From the start of vaccination programme in the UK in late January 2021, the median number of graft rejections per month at Moorfields was 6 (range: 5-9), which was not significantly different to post-lockdown, pre-vaccination programme (March 2020-January 2021), p = 0.367. At OPF, the median rates of rejection before and after initiation of the vaccination programme were not significantly different (p = 0.124). No significant increase in incidence rate of rejection in the risk period following COVID-19 vaccination was found (IRR = 0.53, p = 0.71).No notable increase in rates of transplant rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID-19 vaccination and corneal graft rejection highlighted in several case reports may not represent a causative association.
- Published
- 2022
18. Intravitreal dexamethasone to manage post endothelial keratoplasty cystoid macular oedema refractory to topical therapy
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Jesse Panthagani, Elizabeth M. Law, Caroline Wong, Chimwemwe Chipeta, Harry Roberts, and James Myerscough
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Ophthalmology ,General Medicine - Abstract
Background/Objectives To describe the visual and clinical outcomes of patients with post endothelial keratoplasty (EK) cystoid macular oedema (CMO) refractory to topical treatment with intravitreal sustained-release dexamethasone implant (Ozurdex). Subjects/Methods 131 eyes from 111 patients undergoing solitary or combined EK (52 DSAEK (40.0%) and 79 DMEK (60.0%)) at Southend University Hospital between January 2020 and February 2022 with a minimum follow-up of 6 months were evaluated. Patients suspected of having CMO underwent spectral-domain macular optical coherence tomography (SD-OCT) Patients with diabetes were not included in this series. Results CMO was identified in 5.3% (n = 7) of cases, with 2 of these patients responding to topical corticosteroid treatment. The remaining 5 patients underwent intravitreal dexamethasone implant, with 1 patient requiring repeat implant due to CMO recurrence. All presented within 2 months postoperatively. 4 out of 5 eyes treated with intravitreal dexamethasone achieved a Snellen BCVA ≤6/9.5. 1 patient had an uncontrolled rise in intraocular pressure (IOP) despite maximal medical treatment requiring an urgent PreserFlo Ab-Externo MicroShunt. Conclusions The use of intravitreal sustained-release dexamethasone implant in the management of post EK CMO refractory to topical therapy is effective and safe in most cases, but patients should be monitored and treated promptly for any secondary IOP response.
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- 2023
19. Ten-year outcomes of microkeratome-assisted lamellar keratoplasty for keratoconus
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Sergiu Socea, Cristina Bovone, Elena Franco, Fiorella Fusco, Angeli Christy Yu, Rossella Spena, Massimo Busin, James Myerscough, and Lorenzo Caruso
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Keratoconus ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Scars ,Lamellar keratoplasty ,Astigmatism ,Refraction, Ocular ,NO ,Cornea ,Corneal Transplantation ,Cellular and Molecular Neuroscience ,Treatment Surgery ,Ectasia ,Microkeratome ,Ophthalmology ,medicine ,Humans ,Retrospective Studies ,business.industry ,medicine.disease ,Sensory Systems ,Treatment Outcome ,medicine.anatomical_structure ,Cornea, Treatment Surgery, Corneal Transplantation, Keratoconus ,medicine.symptom ,business ,Keratoplasty, Penetrating ,Dilatation, Pathologic ,Follow-Up Studies - Abstract
Background/AimsTo report the 10-year outcomes of modified microkeratome-assisted lamellar keratoplasty (LK) for keratoconus.MethodsIn this single-centre interventional case series, 151 consecutive eyes with keratoconus underwent modified microkeratome-assisted LK. Eyes with scars extending beyond the posterior half of the corneal stroma and preoperative thinnest-point pachymetry value of less than 300 μm were excluded. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, immunological rejection, ectasia recurrence and graft failure rates.ResultsBaseline BSCVA (0.89±0.31 logarithm of the minimum angle of resolution (logMAR)) significantly improved to 0.10±0.12 logMAR at year 3 (pConclusionModified microkeratome-assisted LK results in stable visual and refractive outcomes with low rates of immunological rejection and graft failure in the absence of recurrence of ectasia for at least 10 years.
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- 2020
20. Blinding ocular trauma caused by remote controlled aerial drone
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Harry W Roberts, James Myerscough, Mohamed Seifelnasr, and Haseeb Akram
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0301 basic medicine ,medicine.medical_specialty ,Blinding ,genetic structures ,Images In… ,Anterior Chamber ,Iris ,Ocular trauma ,030105 genetics & heredity ,03 medical and health sciences ,0302 clinical medicine ,Eye Injuries ,Ophthalmology ,Medicine ,Penetrating Eye Injury ,Humans ,Iris (anatomy) ,Monocular Blindness ,business.industry ,General Medicine ,eye diseases ,Drone ,medicine.anatomical_structure ,sense organs ,business ,030217 neurology & neurosurgery - Abstract
We describe a case of immediate and irreversible monocular blindness secondary to expulsion of the majority of uveal tissue due to penetrating eye injury by the rotating rotor blades of a remote-controlled drone. A middle-aged man presented to the eye clinic having been struck in the right eye a
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- 2021
21. Ultrastructural Alterations of Grafted Corneal Buttons: The Anatomic Basis for Stromal Peeling Along a Natural Plane of Separation
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James Myerscough, Cristina Bovone, Yoav Nahum, Erika Rimondi, Angeli Christy Yu, Vincenzo Scorcia, and Massimo Busin
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Keratoconus ,medicine.medical_specialty ,Stromal cell ,genetic structures ,Corneal Stroma ,Visual Acuity ,NO ,Collagen fibril ,Keratitis ,Cornea ,Corneal Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Stroma ,Ophthalmology ,Medicine ,Humans ,030304 developmental biology ,0303 health sciences ,business.industry ,Dystrophy ,medicine.disease ,eye diseases ,Tissue Donors ,Multicenter study ,030221 ophthalmology & optometry ,Ultrastructure ,sense organs ,business ,Keratoplasty, Penetrating - Abstract
Purpose To examine the ultrastructure of the natural plane of separation in grafted corneas and evaluate the outcomes of stromal peeling. Design Interventional case series. Methods In this multicenter study, stromal peeling was attempted in 96 consecutive eyes with unsatisfactory vision following penetrating keratoplasty (PK) for keratoconus (n = 79), herpetic keratitis (n = 11), and granular dystrophy (n = 6). Stromal exchange was performed by (1) 9 mm partial-thickness trephination; (2) creation of a corneal flap across the PK wound; (3) opening of the stromal component of the PK wound until a smooth, translucent natural plane was identified; (4) severing the attachment of the PK scar; (5) stromal peeling along the identified plane; and (6) suturing of donor lamella. Grafted corneas from cases that mandated conversion to PK were processed for transmission electron microscopy. Results The natural plane of separation was identified in all cases. Stromal exchange was successfully completed in 84 cases (87.5%). Snellen visual acuity ≥20/40 and ≥20/25 was reached in 93% and 72% of cases at 3 years (n = 49) and 86% and 62% at 4 years (n = 21) postoperatively. Mean endothelial cell loss at 1 year was 6.6% ± 9.5%. Stromal peeling occurred along a plane lined with a continuous layer of keratocytes separating pre-Descemet membrane (DM) stroma, DM, and endothelium from the anterior stroma. Pre-DM stroma was made of poorly organized lamellae containing widely spaced, randomly arranged collagen fibrils. Conclusions Ultrastructural alterations in the stromal microarchitecture of grafted corneas provide evidence of a natural plane of separation identified intraoperatively. Stromal peeling can be successfully performed in post-PK eyes with various stromal pathology.
- Published
- 2021
22. Donor‐to‐host transmission of infection: contrasting outcomes of lamellar and penetrating keratoplasty
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James Myerscough, Emilio C. Campos, Vincenzo Scorcia, Cristina Bovone, Massimo Busin, and Giuseppe Giannaccare
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Transplantation ,transmission of infection ,business.industry ,penetrasting keratoplasty, DSAEK, candida species, transmission of infection ,Socio-culturale ,Virology ,Tissue Donors ,Corneal Transplantation ,penetrasting keratoplasty ,Donor to host transmission ,Humans ,Medicine ,Lamellar structure ,candida species ,DSAEK ,business ,Keratoplasty, Penetrating - Published
- 2020
23. Autologous Descemet Stripping Automated Endothelial Keratoplasty to Eliminate Endothelial Rejection in Eyes at High Risk
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Cristina Bovone, Asaf Friehmann, Massimo Busin, and James Myerscough
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autologous keratoplasty, Descemet stripping automated endothelial keratoplasty, endothelial rejection ,Adult ,Graft Rejection ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Visual Acuity ,Socio-culturale ,Context (language use) ,Transplantation, Autologous ,Corneal Diseases ,03 medical and health sciences ,0302 clinical medicine ,Ophthalmology ,medicine ,Humans ,Prospective Studies ,business.industry ,Endothelium, Corneal ,Graft Survival ,Panuveitis ,Retinal detachment ,medicine.disease ,Descemet stripping automated endothelial keratoplasty ,Tissue Donors ,eye diseases ,Endothelial cell density ,autologous keratoplasty ,endothelial rejection ,Descemet Stripping Endothelial Keratoplasty ,030221 ophthalmology & optometry ,Referral center ,Female ,sense organs ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Purpose To determine whether autologous Descemet stripping endothelial keratoplasty is technically feasible and whether it eliminates the risk of endothelial rejection in "only eyes" at high risk of immunological rejection. Methods This is a prospective observational interventional study from 2016 to 2018 with a 24-month follow-up in a tertiary-level corneal referral center, Forli, Italy. One 25-year-old woman with failed penetrating keratoplasty after endothelial rejection in the context of chronic panuveitis and a blind fellow eye due to retinal detachment underwent autologous Descemet stripping automated keratoplasty. An endothelial graft was harvested from the fellow eye by performing a hinged, microkeratome-assisted superficial stromal flap, with removal of the central posterior stromal bed. The posterior lamellar graft created was then transplanted into the other eye using a standardized Descemet stripping automated endothelial keratoplasty (DSAEK) technique. Main outcome measures were endothelial rejection, best spectacle-corrected visual acuity, and endothelial cell density. Results No endothelial rejection was seen during the 2-year follow-up duration. Stable improvement in best spectacle-corrected visual acuity from 0.2 to 0.4 (decimal Snellen) was observed. Endothelial cell density of 1465 (cells/mm) was recorded at the final follow-up. Conclusions The use of this repeatable technique to harvest and transplant an autologous DSAEK graft eliminates endothelial rejection in high-risk eyes.
- Published
- 2019
24. Comparison of corneal densitometry between big-bubble and visco-bubble deep anterior lamellar keratoplasty
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Vincenzo Scorcia, Valentina De Luca, James Myerscough, Mauro Soda, Marco Balestrieri, Massimo Busin, Andrea Lucisano, and D Bruzzichessi
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Adult ,Male ,Keratoconus ,medicine.medical_specialty ,Visual acuity ,Scheimpflug principle ,Group ii ,Visual Acuity ,Lamellar keratoplasty ,Cell Count ,Cornea ,Cellular and Molecular Neuroscience ,Ophthalmology ,medicine ,Humans ,Prospective Studies ,business.industry ,Significant difference ,Corneal Topography ,medicine.disease ,Sensory Systems ,Treatment Outcome ,medicine.anatomical_structure ,Female ,medicine.symptom ,Densitometry ,business ,Keratoplasty, Penetrating ,Follow-Up Studies - Abstract
AimsTo evaluate deep corneal densitometry and visual outcomes after big-bubble (BB-DALK) and visco-bubble (VB-DALK) deep anterior lamellar keratoplasty performed in patients with keratoconus.MethodsProspective comparative study of 50 advanced keratoconic patients who underwent DALK surgery; 25 eyes (group I) were completed with BB-DALK and 25 eyes (group II) with VB-DALK after the failure of pneumatic dissection. Best spectacle-corrected visual acuity (BSCVA), corneal tomographic parameters and endothelial cell count were recorded 1, 3, 6, 12 and 24 months after surgery. Densitometric analysis of the deep corneal interface was obtained using Scheimpflug tomography at each visit; values recorded were compared between the two groups and statistically analysed.ResultsBSCVA was significantly better in the BB-DALK group than the VB-DALK group (0.39±0.29 vs 0.65±0.23 logarithm of the minimum angle of resolution, respectively) for the first 3 months; and in the same time period, densitometry was significantly higher in the VB-DALK group than those recorded in the BB-DALK group (23.97±5.34 vs 17.13±4.44 grayscale units). However, densitometric values and visual acuity did not differ significantly in the two groups at 1 year. No statistically significant difference for the other variables analysed at any time frame was found.ConclusionThe use of viscoelastic substance in the VB-DALK technique may induce modification of interface stromal reflectivity resulting in reduced visual acuity up to 3 months postoperatively. However, this initial negative effect on the interface quality does not affect the long-term visual outcome, with densitometric values and visual outcomes similar in the two groups from 6 months postoperatively.
- Published
- 2019
25. Tectonic Mini-DSAEK Facilitates Closure of Corneal Perforation in Eyes With Healthy Endothelium
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Malik Moledina, Mohamed Seifelnasr, Harry W Roberts, and James Myerscough
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Male ,medicine.medical_specialty ,Microsurgery ,Visual acuity ,genetic structures ,Endothelium ,medicine.medical_treatment ,Perforation (oil well) ,Astigmatism ,03 medical and health sciences ,0302 clinical medicine ,Ophthalmology ,Medicine ,Humans ,Dioptre ,Aged ,business.industry ,Corneal Perforation ,Endothelium, Corneal ,Graft Survival ,Cataract surgery ,Corneal perforation ,medicine.disease ,eye diseases ,medicine.anatomical_structure ,Snellen Fraction ,030221 ophthalmology & optometry ,sense organs ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Descemet Stripping Endothelial Keratoplasty - Abstract
PURPOSE The purpose of this study was to report a surgical technique for closure of a traumatic corneal perforation in a patient with healthy endothelium. METHODS A 69-year-old male patient presented to Southend University Hospital with a 2.5 mm round temporal corneal perforation caused by a metallic foreign body from an industrial accident. Best-corrected visual acuity at presentation was 6/36. The patient received a tectonic small diameter Descemet stripping automated endothelial keratoplasty (mini-DSAEK) to close the perforation. The patient subsequently developed traumatic cataract and underwent cataract surgery 8 months later. Clinical outcomes at 1 week, 1 month, 3 months, 6 months, and 9 months were evaluated. The primary outcomes of interest were successful sustained closure of the perforation and surgical complications, with secondary outcomes of best-spectacle corrected visual acuity (BSCVA, Snellen) and keratometric astigmatism (KA, Pentacam). RESULTS The anterior chamber was reformed by the graft, restoring the globe's mechanical integrity. The bare stroma reepithelized by 1 week. Neither intraoperative nor postoperative surgical complications were reported. The anterior chamber remained deep and formed during subsequent follow-ups through 9 months. At the 9-month follow-up, final best spectacle-corrected visual acuity was 6/6-1 (Snellen fraction). Keratometric astigmatism was 1.1 diopters. CONCLUSIONS Tectonic mini-Descemet stripping automated endothelial keratoplasty is a safe technique in the management of corneal perforations too large for tissue adhesives, with a low astigmatic profile and rapid visual recovery.
- Published
- 2020
26. Interface Drainage and Antimicrobial Irrigation Avoid Repeat Keratoplasty for Post-DSAEK Cold Interface Abscess
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Luca Furiosi, Sergiu Socea, Massimo Busin, James Myerscough, Rossella Spena, Angeli Christy Yu, and Cristina Bovone
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Reoperation ,medicine.medical_specialty ,Microbiological culture ,Visual acuity ,Antifungal Agents ,Eye Infections ,Socio-culturale ,Suction ,Keratitis ,medicine ,Humans ,interface abscess drainage ,Abscess ,DSAEK ,Corneal Ulcer ,Therapeutic Irrigation ,interface infection ,Aged ,Retrospective Studies ,business.industry ,Candidiasis ,medicine.disease ,Antimicrobial ,Surgery ,Cold abscess ,Posterior segment of eyeball ,Ophthalmology ,Fungal ,Histopathology ,Female ,Voriconazole ,medicine.symptom ,business ,Eye Infections, Fungal ,Descemet Stripping Endothelial Keratoplasty - Abstract
PURPOSE To describe a surgical technique for the diagnosis and treatment of post-Descemet stripping automated endothelial keratoplasty (DSAEK) infectious interface keratitis presenting as a cold abscess. METHODS This study included 2 eyes of 2 patients that developed delayed-onset interface infections after DSAEK. Through an anterior keratotomy, diagnostic samples for microbial culture and histopathology examination were collected, and empiric antibiotic therapy was delivered directly to the site of the infection at the graft-host interface. RESULTS In both cases, microbiological examinations confirmed a fungal etiology consistent with Candida. Resolution of infection was achieved, and no signs of posterior segment involvement or recurrence of infection were observed. Both corneas remained clear with final visual acuity of 20/25 and 20/32. No case required additional surgical intervention or repeat keratoplasty after more than 15 months of follow-up. CONCLUSIONS Interface drainage with antimicrobial irrigation may be considered for the management of post-DSAEK interface infections presenting as a peripheral cold abscess. By avoiding intraocular seeding of infectious pathogens, the anterior approach can achieve clinical resolution of infection, maintain visual function, and preserve the DSAEK graft, thereby obviating the need for a therapeutic keratoplasty.
- Published
- 2020
27. Negative polymerase chain reaction for SARS-CoV-2 in aqueous sample of patient with confirmed SARS-CoV-2 and recurrence of herpetic stromal keratitis
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James Myerscough, Harry W Roberts, and Haseeb Akram
- Subjects
Male ,Stromal keratitis ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Corneal Stroma ,Visual Acuity ,Context (language use) ,Antiviral Agents ,Virus ,law.invention ,Keratitis ,Aqueous Humor ,03 medical and health sciences ,0302 clinical medicine ,law ,Recurrence ,Medicine ,Humans ,Simplexvirus ,skin and connective tissue diseases ,Ganciclovir ,Polymerase chain reaction ,business.industry ,Reverse Transcriptase Polymerase Chain Reaction ,SARS-CoV-2 ,fungi ,COVID-19 ,respiratory system ,Middle Aged ,medicine.disease ,Virology ,Sensory Systems ,body regions ,Ophthalmology ,Nasal Swab ,COVID-19 Nucleic Acid Testing ,030221 ophthalmology & optometry ,Keratitis, Herpetic ,Surgery ,business ,Viral load ,030217 neurology & neurosurgery - Abstract
This case report describes a negative result for antigen testing for the SARS-CoV-2 virus in an aqueous sample taken during the management of suspected herpes simplex keratitis from a patient with confirmed SARS-CoV-2 based on antigen testing of high nasal swab. The implications of no viral load detectable in the aqueous sample are discussed in context of routine phacoemulsification surgery during the SARS-CoV-2 pandemic.
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- 2020
28. Microthin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty: A Randomized Clinical Trial
- Author
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Hammad Sarwar, Girinath Nandakumar, Mrinal Rana, Artemis Matsou, Susan M Thomson, Jufen Zhang, Madhavan S. Rajan, James Myerscough, and Rathin Pujari
- Subjects
Male ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Visual Acuity ,Cell Count ,Fuchs' dystrophy ,Refraction, Ocular ,law.invention ,Postoperative Complications ,Randomized controlled trial ,Quality of life ,Double-Blind Method ,law ,Ophthalmology ,medicine ,Humans ,Decompensation ,Prospective Studies ,Aged ,Aged, 80 and over ,Corneal Decompensation ,Keratometer ,business.industry ,Endothelium, Corneal ,Fuchs' Endothelial Dystrophy ,Middle Aged ,medicine.disease ,eye diseases ,Treatment Outcome ,Patient Satisfaction ,Quality of Life ,Female ,medicine.symptom ,business ,Complication ,Descemet Stripping Endothelial Keratoplasty - Abstract
Purpose To compare visual outcomes, complications, and vision-related quality of life (QoL) after microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the management of corneal endothelial dysfunction in Fuchs dystrophy. Methods This is a prospective, double-blinded randomized controlled clinical trial. Patients with visually significant endothelial decompensation from Fuchs dystrophy were prospectively randomized to receive MT-DSAEK or DMEK surgery. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 12 months. Secondary outcomes included refraction, keratometry, endothelial cell count, complications, and vision-related QoL at 6 and 12 months postoperatively. Results A total of 56 eyes of 56 patients were enrolled, 28 in each group. Postoperatively, LogMAR mean BSCVA in the MT-DSAEK group was 0.17 ± 0.08 and 0.11 ± 0.09 at 6 and 12 months compared with 0.09 ± 0.13 and 0.04 ± 0.13 after DMEK (P = 0.03, P = 0.002 respectively) with the DMEK cohort achieving 3.5 logarithm of the minimum angle of resolution letters better BSCVA at 1 year compared with MT-DSAEK. Complication rates were similar with 3.5% rebubbling rate in both groups, 1 primary graft failure in DMEK and a single endothelial rejection in the MT-DSAEK arm. Vision-related QoL was comparable at 6 and 12 months postoperatively, and no eyes demonstrated loss of vision from preoperative BSCVA. Conclusions DMEK surgery resulted in significantly better BSCVA at 1, 3, 6, and 12 months postoperatively compared with MT-DSAEK. Patient satisfaction was similar with no differences reported in vision-related QoL scores, as was the complications profile between groups. Thus, our results favor DMEK as the better choice procedure for eyes with Fuchs-related corneal decompensation without ocular comorbidities.
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- 2020
29. Stromal peeling for deep anterior lamellar keratoplasty in post-penetrating keratoplasty eyes
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Yoav Nahum, Angeli Christy Yu, Giuseppe Giannaccare, Massimo Busin, James Myerscough, Rossella Spena, Vincenzo Scorcia, and Cristina Bovone
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Keratoconus ,Stromal cell ,Visual acuity ,genetic structures ,Visual Acuity ,Lamellar keratoplasty ,Socio-culturale ,Dissection (medical) ,treatment surgery ,Cornea ,Corneal Transplantation ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Suture (anatomy) ,Ophthalmology ,Microkeratome ,medicine ,Humans ,Retrospective Studies ,business.industry ,medicine.disease ,Sensory Systems ,030104 developmental biology ,medicine.anatomical_structure ,Treatment Outcome ,030221 ophthalmology & optometry ,Skin Abnormalities ,medicine.symptom ,business ,Keratoplasty, Penetrating - Abstract
Background/aimsTo evaluate the clinical outcomes of deep anterior lamellar keratoplasty performed by stromal peeling in eyes that have previously undergone penetrating keratoplasty (PK) for keratoconus.MethodsStandardised stromal exchange included (1) 9 mm trephination of the recipient bed outside the old PK wound, (2) creation of a partial anterior corneal flap through lamellar dissection across the PK wound, (3) opening the stromal component of the old PK wound using blunt-tipped Vannas scissors until a plane of separation is reached, (4) severing the attachment of the PK surgical scar from the recipient host, (5) peeling the stroma of the PK graft from the underlying tissue and (6) suturing the donor anterior corneal lamella prepared by microkeratome dissection (450 µm depth, 9 mm diameter). Main outcome measures were success rate, best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss (ECL).ResultsOf 21 post-PK eyes, stromal exchange succeeded in all but three cases, which were converted to a two-piece mushroom PK. After complete suture removal, mean BSCVA significantly improved from 0.95±0.39 logMAR preoperatively to 0.23±0.17 logMAR (pConclusionIn post-PK eyes, stromal exchange can be performed by means of simple peeling without deep anterior lamellar dissection of the previous PK graft. Large-diameter (9 mm) repeat keratoplasty through stromal peeling yields excellent visual outcomes and minimal ECL. Double anterior chamber formation may complicate the postoperative course, but prompt intervention allows successful management.
- Published
- 2020
30. Reply To Comment on Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus
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Massimo Busin, Gabriele Piccoli, James Myerscough, Andrea Lucisano, Giovanna Carnovale Scalzo, Marco Pellegrini, Francesco Verdoliva, Giuseppe Giannaccare, Mauro Soda, Vincenzo Scorcia, and Cristina Bovone
- Subjects
medicine.medical_specialty ,Keratoconus ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Dissection ,Lamellar keratoplasty ,Corneal Topography ,Dissection (medical) ,Corneal topography ,medicine.disease ,NO ,Corneal Transplantation ,Ophthalmology ,medicine ,Humans ,Liquid bubble ,business ,Corneal transplantation - Published
- 2020
31. Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus
- Author
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Angeli Christy Yu, James Myerscough, Harry W Roberts, Massimo Busin, Mohamed Elkadim, and Cristina Bovone
- Subjects
Adult ,Male ,Keratoconus ,medicine.medical_specialty ,Visual acuity ,Time Factors ,Visual Acuity ,Lamellar keratoplasty ,Astigmatism ,Refraction, Ocular ,NO ,Cornea ,03 medical and health sciences ,0302 clinical medicine ,Ophthalmology ,medicine ,Humans ,Dioptre ,030304 developmental biology ,Retrospective Studies ,0303 health sciences ,Surgical approach ,medicine.diagnostic_test ,business.industry ,Corneal Topography ,descemets membrane ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Corneal topography ,Penetrating keratoplasty, descemets membrane, Visual Acuity ,Treatment Outcome ,030221 ophthalmology & optometry ,Female ,medicine.symptom ,business ,Keratoplasty, Penetrating ,Penetrating keratoplasty ,Follow-Up Studies - Abstract
To compare the 5-year outcomes of 9-mm-deep anterior lamellar keratoplasty (DALK) for keratoconus with those of conversions to mushroom keratoplasty (MK).Retrospective cohort study.The setting was the Ospedali Privati Villa Igea, Department of Ophthalmology, Forlì, Italy. The study population consisted of the medical records of all attempted DALK procedures (416 eyes) for the indication of keratoconus performed between January 2012 and January 2018; 68 eyes (16.4%) were converted to MK and analyzed as a separate cohort. The mean follow-up time was 33.8 ± 15.1 months. Procedure(s) consisted of 9-mm DALK and MK (9-mm anterior lamella with 6-mm posterior lamella). Outcome measurements were best-corrected visual acuity (BCVA), refractive astigmatism, and endothelial cell loss (ECL) at 5 years.Average BCVA at 5 years was 0.06 ± 0.07 in the DALK group and 0.09 ± 0.15 in the MK group (P = .88). Refractive astigmatism following suture removal (all visits later than 12 months) was slightly less in the DALK cohort (5-year DALK = 2.16 ± 1.40 diopter [D]; MK = 3.02 ± 0.89 D; P = .04; mean difference = 0.86 D [95% confidence interval [CI]: 0.71-1.01]). ECL was significantly higher in the MK group than in the DALK group at all follow-up intervals (5-year DALK = 19.36 ± 21.47%; MK = 56.61 ± 15.82%; P.001). The total all-cause graft failure rate at 5 years was 0.58% for DALK (2 of 348) cases and 5.88% for MK (4 of 68) cases.Excellent 5-year visual and clinical outcomes associated with a 2-piece MK in cases converted from intended DALK mandate large-diameter DALK (9 mm) as the optimal surgical approach to keratoconus.
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- 2020
32. Evaluation of the risk factors associated with conversion of intended deep anterior lamellar keratoplasty to penetrating keratoplasty
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Cristina Bovone, Asaf Friehmann, Massimo Busin, James Myerscough, and Michael Mimouni
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Adult ,Male ,medicine.medical_specialty ,Keratoconus ,Multivariate analysis ,Adolescent ,Visual Acuity ,Lamellar keratoplasty ,Socio-culturale ,Risk Assessment ,Cornea ,Cellular and Molecular Neuroscience ,Young Adult ,Postoperative Complications ,Risk Factors ,Statistical significance ,Medicine ,Humans ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,business.industry ,Incidence ,Corneal Topography ,Middle Aged ,medicine.disease ,Prognosis ,Sensory Systems ,Surgery ,Ophthalmology ,Dissection ,medicine.anatomical_structure ,Italy ,Child, Preschool ,Female ,business ,Keratoplasty, Penetrating ,Cohort study ,Follow-Up Studies - Abstract
Background/aimsTo identify and evaluate risk factors associated with the need to convert intended deep anterior lamellar keratoplasty (DALK) to penetrating keratoplasty (PK).MethodsRetrospective institutional cohort study including all consecutive eyes undergoing intended DALK between May 2015 and October 2018 at ‘Villa Igea’ Hospital (Forli, Italy). The indications for surgery were categorised as (1) keratoconus without scarring; (2) keratoconus with scarring; (3) non-keratoconus without scarring; and (4) non-keratoconus with scarring. Multivariate binary logistic regression analysis was performed, introducing, as independent variables, those that reached a significance level of less than 0.05 in univariate analysis. The main outcome measure was whether or not conversion to a PK occurred.Results705 eyes were included, with conversion to PK occurring in 16.2% (n=114) of cases. The factors that remained significant in multivariate analysis were corneal scarring (OR=3.52, pConclusionOccurrence of a type 2 bubble, the need for manual dissection, the presence of scarring and surgeon inexperience are independent risk factors for the need to convert intended DALK to PK. Correct identification and management of the type of bubble achieved during pneumatic dissection is instrumental in minimising the rate of conversion to PK.
- Published
- 2020
33. Three-Year Outcomes of Tri-Folded Endothelium-In Descemet Membrane Endothelial Keratoplasty With Pull-Through Technique
- Author
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Luigi De Rosa, Sergiu Socea, Rossella Spena, James Myerscough, Cristina Bovone, Angeli Christy Yu, Massimo Busin, Luca Furiosi, and Fiorella Fusco
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Visual acuity ,genetic structures ,Descemet membrane ,Endothelium ,air tamponade ,Visual Acuity ,Cell Count ,NO ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Pull-through technique ,Ophthalmology ,medicine ,Humans ,cell loss ,Descemet Membrane ,Aged ,030304 developmental biology ,Aged, 80 and over ,0303 health sciences ,business.industry ,Endothelium, Corneal ,Fuchs' Endothelial Dystrophy ,Graft Survival ,sulfur-hexafluoride SF6 ,Corneal Endothelial Cell Loss ,Middle Aged ,penetrating keratoplasty ,sulfur-hexafluoride SF6, cystoid macular edema, penetrating keratoplasty, air tamponade, cell loss ,Tissue Donors ,Endothelial cell density ,Treatment Outcome ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,Bullous keratopathy ,Female ,medicine.symptom ,Complication ,business ,Descemet Stripping Endothelial Keratoplasty ,Fuchs Endothelial Corneal Dystrophy ,cystoid macular edema ,Follow-Up Studies - Abstract
To assess the 3-year outcomes of tri-folded endothelium-in Descemet membrane endothelial keratoplasty (DMEK) using bimanual pull-through delivery technique.Interventional case series.In this single-center study, we included 153 consecutive eyes that underwent DMEK for various indications (Fuchs endothelial corneal dystrophy [FECD]: n = 111; bullous keratopathy [BK]: n = 24; and failed graft: n = 18). DMEK grafts were loaded into a disposable cartridge in a tri-folded, endothelium-in configuration and delivered using bimanual pull-through technique. Main outcome measures were graft preparation and unfolding times, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft survival.Mean graft preparation time was 5.9 ± 1.1 minutes; and mean graft unfolding time was 2.9 ± 0.9 minutes. Excluding eyes with comorbidities, logarithm of minimum angle of resolution BSCVA improved significantly from baseline preoperative values of 0.92 ± 0.58 to 0.02 ± 0.07 at 1 year (P.001) and remained stable up to 3 years. Mean postoperative ECD decreased significantly (P.001) from eye bank values to 1,818 ± 362, 1,675 ± 372, and 1,580 ± 423 cells/mmTri-folded endothelium-in DMEK requires minimal time for graft unfolding, which is the surgical step considered most challenging by corneal surgeons. Visual outcomes and complication rates are not adversely affected by the modification of the surgical technique.
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- 2020
34. Initial High-Dose Prophylaxis and Extended Taper for Mushroom Keratoplasty in Vascularized Herpetic Scars
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Sergiu Socea, Angeli Christy Yu, Massimo Busin, James Myerscough, Asaf Friehmann, Guiseppe Giannaccare, Cristina Bovone, and Luca Furiosi
- Subjects
Male ,Visual acuity ,genetic structures ,Visual Acuity ,Eye Infections, Viral ,Scars ,Cornea ,Postoperative Complications ,0302 clinical medicine ,Medicine ,Prospective Studies ,Child ,Prospective cohort study ,Aged, 80 and over ,0303 health sciences ,Graft Survival ,Antiviral Prophylaxis, Corneal Scarring, Herpes Keratitis, Mushroom Keratoplasty ,Middle Aged ,Endothelial cell density ,Corneal Scarring ,Female ,medicine.symptom ,Adult ,medicine.medical_specialty ,Adolescent ,Socio-culturale ,Astigmatism ,Refraction, Ocular ,Slit Lamp Microscopy ,Keratitis ,Mushroom Keratoplasty ,Cicatrix ,Young Adult ,03 medical and health sciences ,Antiviral Prophylaxis ,Humans ,Glucocorticoids ,Corneal Scar ,Aged ,030304 developmental biology ,Dose-Response Relationship, Drug ,business.industry ,Eye infection ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,Keratitis, Herpetic ,030221 ophthalmology & optometry ,Herpes Keratitis ,business ,Descemet Stripping Endothelial Keratoplasty - Abstract
To report the outcomes of initial high-dose and extended taper of antiviral and steroid prophylaxis for the treatment of eyes with high-risk vascularized herpetic corneal scars that underwent 2-piece mushroom keratoplasty (MK).Prospective interventional case series.In this single-center study, 52 consecutive eyes with vascularized (≥2 quadrants) herpetic corneal scars underwent 2-piece microkeratome-assisted MK. Initial high-dose and extended taper of combined oral and topical antiviral and steroid prophylaxis was administered. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, immunologic rejection, herpetic recurrence, and graft failure rates.Excluding patients with vision-impairing comorbidities, baseline BSCVA (1.73 ± 0.67 logMAR) significantly improved annually during the first 2 years (P.001, P = .016), reaching 0.17 ± 0.18 logMAR at year 2, and remaining stable up to 10 years (P = .662). At 2 years, 86% of eyes saw ≥20/40, 55% saw ≥20/25, and 18% saw ≥20/20 Snellen BSCVA. RA exceeded 4.5 diopters in 7% of cases after wound revision for high-degree astigmatism in 7 cases. Endothelial cell loss was 40.9% at 1 year with an annual decline of 3.1% over 10 years. The 10-year cumulative risk for immunologic rejection, herpetic recurrence, and graft failure was 9.7%, 7.8%, and 7.6%, respectively.Initial high dose and extended taper of antiviral and steroid prophylaxis for MK in high-risk, vascularized herpetic corneal scars achieves clinical outcomes that remain stable for up to 10 years after surgery with minimal risk of immunologic rejection, herpetic recurrence and graft failure.
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- 2020
35. Predictors of Bubble Formation and Type Obtained with Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus
- Author
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Cristina Bovone, James Myerscough, Vincenzo Scorcia, Giovanna Carnovale Scalzo, Gabriele Piccoli, Giuseppe Giannaccare, Mauro Soda, Andrea Lucisano, Massimo Busin, Francesco Verdoliva, Marco Pellegrini, and Scorcia V, Giannaccare G, Lucisano A, Soda M, Scalzo GC, Myerscough J, Pellegrini M, Verdoliva F, Piccoli G, Bovone C, Busin M
- Subjects
medicine.medical_specialty ,Keratoconus ,keratoconus ,Bubble ,Socio-culturale ,Astigmatism ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Ectasia ,Ophthalmology ,medicine ,pneumatic dissection ,030304 developmental biology ,lamellar keratoplasty, pneumatic dissection, keratoconus ,0303 health sciences ,Keratometer ,DALK, keratoconus, bubble, predictors ,business.industry ,Retrospective cohort study ,medicine.disease ,Dissection ,030221 ophthalmology & optometry ,Liquid bubble ,lamellar keratoplasty ,business - Abstract
PURPOSE: To identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity. DESIGN: Retrospective Cohort Study. METHODS: Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to Feb- ruary 2019; Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment Optical Coherence Tomography (AS-OCT)-based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro/macro-perforation; conver- sion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types. RESULTS: Pneumatic dissection succeeded in 113/155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%) and 2 mixed-type (1.8%). Micro-perforations were managed conservatively in type-1 bubbles; macro-perforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P=0.006 and P
- Published
- 2020
36. Successful Descemet Membrane Endothelial Keratoplasty in Proven Herpetic Endothelial Decompensation Requires Intensive Antiviral Therapy
- Author
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Asaf Friehmann, Massimo Busin, James Myerscough, Cristina Bovone, Giuseppe Giannaccare, and Maria Mazzoni
- Subjects
Male ,medicine.medical_specialty ,Visual acuity ,Endothelium ,Visual Acuity ,Acyclovir ,Administration, Oral ,Administration, Ophthalmic ,DMEK ,Herpesvirus 1, Human ,Slit Lamp Microscopy ,Antiviral Agents ,Keratitis ,NO ,medicine ,Humans ,Decompensation ,Ganciclovir ,Endotheliitis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Endothelium, Corneal ,Graft Survival ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Herpetic corneal decompensation ,Combined Modality Therapy ,Surgery ,Endothelial stem cell ,Ophthalmology ,medicine.anatomical_structure ,Descemet Stripping Endothelial Keratoplasty ,Keratitis, Herpetic ,Female ,medicine.symptom ,Corneal edema ,business ,Corneal edema, DMEK, Endotheliitis, Herpetic corneal decompensation ,Tomography, Optical Coherence - Abstract
Purpose To report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with intensive antiviral therapy for corneal edema secondary to herpes simplex virus type 1 (HSV-1)-mediated endotheliitis. Methods All eyes with polymerase chain reaction positive for HSV-1 undergoing DMEK for endothelial decompensation between January 2014 and January 2018 were followed up prospectively at our tertiary referral center. All eyes had been free of active inflammation for a minimum of 9 months and were treated prophylactically with high-dose systemic and topical antivirals, which were continued for a prolonged period of time. Primary outcomes were the occurrence of immunological rejection and/or recurrence of endotheliitis, eventually resulting in graft failure. Secondary outcomes were best spectacle-corrected visual acuity and endothelial cell loss. Results Four consecutive eyes of 4 patients were included with a mean (±SD) patient age of 68.5 ± 15.1 years. The postoperative follow-up averaged 22 months. No eyes exhibited any signs of immunologic rejection, recurrence of endotheliitis, or graft failure. Mean (±SD) decimal best spectacle-corrected visual acuity improved from 0.2 ± 0.1 to 0.7 ± 0.2 (P = 0.007), whereas mean (±SD) endothelial cell loss was 56% ± 10.2% at the final postoperative follow-up. Conclusions DMEK is an effective option to treat corneal edema secondary to HSV-1-related endotheliitis. Intensive antiviral prophylaxis may reduce the risk of recurrence and subsequent graft failure.
- Published
- 2019
37. Astigmatism Orientation After Deep Anterior Lamellar Keratoplasty for Keratoconus and Its Correlation With Preoperative Peripheral Corneal Astigmatism
- Author
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James Myerscough, Massimo Busin, Mohamed Elkadim, and Cristina Bovone
- Subjects
astigmatism, DALK, orientation, prediction, axis ,Adult ,Male ,Keratoconus ,medicine.medical_specialty ,medicine.medical_treatment ,Visual Acuity ,Socio-culturale ,Lamellar keratoplasty ,Astigmatism ,Refraction, Ocular ,orientation ,Corneal Transplantation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,axis ,Ophthalmology ,Orientation (geometry) ,medicine ,Humans ,Corneal transplantation ,Orientation, Spatial ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Corneal Topography ,prediction ,Middle Aged ,medicine.disease ,Corneal topography ,Peripheral ,DALK ,030221 ophthalmology & optometry ,Female ,business ,Corneal astigmatism ,030217 neurology & neurosurgery - Abstract
PURPOSE To evaluate the orientation of keratometric astigmatism (KA) after deep anterior lamellar keratoplasty (DALK) for keratoconus and its correlation with preoperative peripheral KA. METHODS This is a retrospective, single-center observational study including keratoconic patients undergoing DALK between January 2016 and January 2017 with regular astigmatism postoperatively. The orientation of postoperative KA was classified as with-the-rule (WTR), against-the-rule, or oblique and was correlated with the corresponding preoperative peripheral KA, calculated by the sinusoidal fitting of points of the axial keratometric power map at 8 mm diameter. RESULTS Forty-one keratoconic eyes were included, with the most common orientation of KA post-DALK being WTR (65.9%), followed by against-the-rule (19.5%) and oblique (14.6%). A significant correlation was found between preoperative peripheral KA and post-DALK KA regarding axis (P < 0.001, r = 0.88) and power (P = 0.0128, r = 0.23). CONCLUSIONS The axis of post-DALK astigmatism and to a lesser extent its respective power in keratoconic eyes can be predicted using the preoperative peripheral KA, with "WTR" being the most common astigmatic orientation.
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- 2019
38. Deep Trephination Allows High Rates of Successful Pneumatic Dissection for DALK Independent of Surgical Experience
- Author
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James Myerscough, Vincenzo Scorcia, Pia Leon, Yoav Nahum, Benedetta Azzurra Ricci-Filipovic, Massimo Busin, Cristina Bovone, and Michael Mimouni
- Subjects
deep trephination ,Adult ,Male ,medicine.medical_specialty ,Visual acuity ,Corneal Stroma ,Visual Acuity ,Lamellar keratoplasty ,Dissection (medical) ,Keratoconus ,NO ,Corneal Transplantation ,medicine ,Humans ,Retrospective Studies ,High rate ,business.industry ,Dissection ,DALK, deep trephination, learning curve ,Middle Aged ,medicine.disease ,Surgery ,Transplantation ,Ophthalmology ,learning curve ,Multicenter study ,DALK ,Female ,Clinical Competence ,medicine.symptom ,Clinical competence ,business - Abstract
Purpose To evaluate the relationship between surgical experience and the success rate of pneumatic dissection for deep anterior lamellar keratoplasty (DALK) using deep trephination. Methods A noncomparative case series evaluating the first 10 consecutive keratoconic eyes without deep stromal scarring, operated by 8 surgeons of 3 different experience levels, was conducted; there were a total of 80 patients. Standardized DALK was performed, including deep trephination 450 to 550 μm in depth and 9 mm in diameter, pneumatic dissection, removal of the stroma, and transplantation of a 9-mm partial-thickness anterior lamellar graft. The success rate of pneumatic dissection correlated with surgical experience. Results Pneumatic dissection succeeded in 7, 7, 8, and 9 cases of 10 cases in the first group of 4 inexperienced surgeons (under 10 previous keratoplasties of any kind); in 9 and 10 of 10 cases in the second group of 2 relatively experienced surgeons (under 100 keratoplasties); and in 10 and 8 of 10 cases in the third group of 2 very experienced surgeons (more than 1000 previous keratoplasties). No difference between the groups was found to be statistically significant with the χ test (P > 0.05). Conclusions The standardized DALK technique using a deep trephination allows high success rates of pneumatic dissection even for surgeons inexperienced in keratoplasty.
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- 2019
39. Impact of COVID-19 on corneal donation and distribution
- Author
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Gary L.A. Jones, Diego Ponzin, Massimo Busin, James Myerscough, Vito Romano, Mohit Parekh, Stefano Ferrari, Carlo Griffoni, Sajjad Ahmad, and Giuseppe Feltrin
- Subjects
2019-20 coronavirus outbreak ,Tissue and Organ Procurement ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,General Medicine ,Virology ,Tissue Donors ,Cornea ,Corneal Transplantation ,Ophthalmology ,Donation ,Correspondence ,Distribution (pharmacology) ,Medicine ,Humans ,business - Published
- 2020
40. Peripheral Intrastromal Hydration Facilitates Safe, Deep Trephination in Corneas of Irregular Thickness
- Author
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James Myerscough, Asaf Friehmann, Massimo Busin, Francesco Parmeggiani, Mohamed Elkadim, and Cristina Bovone
- Subjects
Adult ,Male ,medicine.medical_specialty ,Corneal Pachymetry ,trephination ,medicine.medical_treatment ,Corneal Stroma ,Perforation (oil well) ,Visual Acuity ,Lamellar keratoplasty ,Organism Hydration Status ,thin cornea ,Refraction, Ocular ,NO ,Corneal Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Suture (anatomy) ,Body Water ,Ophthalmology ,intrastromal hydration ,Medicine ,Humans ,Saline ,Best corrected visual acuity ,business.industry ,Corneal Topography ,DALK ,Middle Aged ,Peripheral ,030221 ophthalmology & optometry ,Female ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
PURPOSE To evaluate the feasibility of regularizing the peripheral corneal thickness before deep trephination in highly irregular corneas undergoing deep anterior lamellar keratoplasty (DALK) by means of intrastromal hydration with saline. METHODS This is an interventional case series including all eyes with irregular peripheral corneal thickness undergoing DALK for any indication between January 1, 2016, and January 1, 2017, at a single tertiary center in Forli, Italy. Before trephination, 1 mL of normal saline was injected intrastromally into each clock hour of peripheral thinning (determined using preoperative pachymetry) using a 30-gauge needle. A deep trephination of 400 to 450 μm was then performed, and DALK was completed as per our previously described technique. Primary outcome measures were perforation during trephination and intraoperative complications, with secondary outcomes of best corrected visual acuity and refraction. RESULTS Peripheral intrastromal hydration was performed in 61 eyes of 61 patients. Intrastromal hydration ensured a safe trephination without perforation into the anterior chamber (AC) in 59 of 61 eyes. In the 2 cases in which perforation occurred, the perforation site was sutured with a full-thickness suture and the surgery was completed successfully. No cases required conversion to penetrating keratoplasty. Intrastromal injection of 1 mL of normal saline resulted in an increase in corneal thickness of 31%. After surgery, double AC was observed in 3 cases (4.9%), with all cases being managed successfully by air injection into the AC. CONCLUSIONS Zonal peripheral intrastromal hydration is a feasible technique to enable safe, deep trephination even in corneas of highly irregular thickness.
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- 2019
41. Sutureless superficial anterior lamellar keratoplasty for recurrent corneal haze after repeat excimer laser surface ablation
- Author
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Michael Mimouni, Sara Padroni, Faisal Aljassar, Cristina Bovone, Peter B M Thomas, Massimo Busin, and James Myerscough
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Haze ,Visual acuity ,Time Factors ,genetic structures ,medicine.medical_treatment ,Visual Acuity ,Socio-culturale ,Refraction, Ocular ,Photorefractive Keratectomy ,Cornea ,Cellular and Molecular Neuroscience ,Phototherapeutic keratectomy ,Corneal Opacity ,Recurrence ,Ophthalmology ,Microkeratome ,medicine ,Myopia ,Humans ,Prospective Studies ,Aged ,Corneal Haze ,business.industry ,keratomileusis ,Corneal Topography ,Middle Aged ,Ablation ,eye diseases ,Sensory Systems ,Photorefractive keratectomy ,Sutureless Surgical Procedures ,medicine.anatomical_structure ,cornea, photorefractive keratectomy, keratomileusis ,Female ,Lasers, Excimer ,sense organs ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Background/AimsTo evaluate the 5-year outcomes of sutureless superficial anterior lamellar keratoplasty (SALK) in the treatment of surface ablation-related corneal haze recurring after phototherapeutic keratectomy (PTK).MethodsProspective interventional study at a tertiary referral centre in Forli, Italy. Ten consecutive eyes with corneal haze following photorefractive keratectomy, recurring after treatment with PTK with or without mitomycin C, undergoing sutureless SALK. Sutureless SALK was performed using a microkeratome in donor and recipient. Main outcome measures: best spectacle-corrected visual acuity (BSCVA), surgically induced astigmatism (SIA), rate of recurrence and complications.ResultsThere were no intraoperative complications and there was no recurrence of haze in any eye postoperatively. BSCVA showed significant improvement at all postoperative time points. Mean preoperative visual acuity improved from 0.46 logMAR units (SD=0.12) to 0.12 (SD=0.12, p=0.0001) at 5 years. At 6 months, SIA was 2.50±1.04 with no further significant change at 5 years (2.53±1.39, p=0.95). There was no significant change in mean spherical equivalent and no significant difference between preoperative and postoperative astigmatism vector values at 5 years.ConclusionsSutureless SALK provides a useful treatment option in patients with recurrent haze after excimer laser treatment. It can eliminate haze recurrence for at least a period of 5 years and can improve BSCVA, although there may be significant SIA.
- Published
- 2019
42. Outcomes of a Modified Technique for Successful Pneumatic Dissection in Pediatric Eyes With Corneal Scars
- Author
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Leila Mattioli, Cristina Bovone, Pia Leon, James Myerscough, Jayne S. Weiss, Rossella Spena, and Massimo Busin
- Subjects
Male ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Adolescent ,Visual Acuity ,Dissection (medical) ,Keratoconus ,Refraction, Ocular ,NO ,Penetrating ,Suture (anatomy) ,Ocular ,medicine ,Humans ,Child ,Corneal Scar ,business.industry ,Dissection ,Modified technique ,medicine.disease ,Cannula ,eye diseases ,Corneal transparency ,Corneal Injuries ,Female ,Keratoplasty, Penetrating ,Surgery ,Refraction ,Ophthalmology ,Ophthalmologic examination ,Keratoplasty ,medicine.symptom ,business - Abstract
PURPOSE To report the outcomes of a modified deep anterior lamellar keratoplasty (DALK) procedure for the treatment of scarred corneas in otherwise healthy pediatric eyes. METHODS All pediatric eyes undergoing DALK by the same surgeon (M.B.) between July 2013 and June 2017 were enrolled. The standard DALK procedure was modified by including a large (9 mm) and deep (150 μm from the thinnest pachymetric measurement) trephination, a minimal cannula advancement from the base of the trephination, and a clearing of a central 6 mm optical zone. The success rates of pneumatic dissection, visual and refractive outcomes, and complications were reported. A complete ophthalmologic examination was performed preoperatively and a few days after suture removal (6-months post-DALK) for all patients as well as 12, 24, and 36 months postoperatively for available patients. RESULTS Fourteen eyes of 13 patients with various indications were included in this study. The mean age at the time of surgery was 11.7 ± 2.5 years. Pneumatic dissection succeeded in all but one case (13/14 eyes = 92.8%), which was completed by hand dissection. All sutures were removed within 6 months of surgery. With a minimum postoperative follow-up of 6 months, best spectacle-corrected visual acuity improved from ≤20/50 to ≥20/40 in all but one eye, which was known to be amblyopic. CONCLUSIONS Despite impaired corneal transparency and increased tissue consistency, a modified DALK technique allows successful pneumatic dissection in an extremely high percentage of scarred pediatric eyes. Visual results compare favorably with those obtained in children after penetrating keratoplasty, while vision threatening complications are minimized.
- Published
- 2019
43. Factors Predictive of Double Anterior Chamber Formation Following Deep Anterior Lamellar Keratoplasty
- Author
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Mohamed Elkadim, Cristina Bovone, James Myerscough, Michael Mimouni, Massimo Busin, and Erika Rimondi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Keratoconus ,Adolescent ,complications ,Anterior Chamber ,Perforation (oil well) ,Visual Acuity ,Lamellar keratoplasty ,Deep anterior lamellar keratoplasty ,NO ,Cornea ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Statistical significance ,medicine ,Humans ,Child ,Aged ,Retrospective Studies ,030304 developmental biology ,Aged, 80 and over ,0303 health sciences ,Univariate analysis ,business.industry ,double chamber formation ,Incidence ,Corneal Topography ,Odds ratio ,Middle Aged ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,Dissection ,Italy ,Child, Preschool ,Deep anterior lamellar keratoplasty, complications, double chamber formation ,030221 ophthalmology & optometry ,Female ,business ,Keratoplasty, Penetrating ,Follow-Up Studies ,Cohort study - Abstract
Purpose To identify risk factors predictive of postoperative double anterior chamber formation after deep anterior lamellar keratoplasty (DALK). Design Retrospective institutional cohort study. Methods The study group included all consecutive eyes undergoing primary DALK between May 2015 and October 2018 at Villa Igea private hospital (Forli, Italy). The indications for surgery were categorized as (1) keratoconus without scarring; (2) keratoconus with scarring; (3) non-keratoconus without scarring; and (4) non-keratoconus with scarring. Multivariate binary logistic regression analysis was performed, introducing, as independent variables, those that reached a significance level of less than .05 in univariate analysis. The main outcome measure was whether or not postoperative double anterior chamber (AC) occurred. Results A total of 591 eyes of 591 patients were included. The main indication for DALK was keratoconus (67.2%, n = 397), and pneumatic dissection was achieved in 72.9% (n = 431) of patients. Postoperative double AC was observed in 8.1% (n = 48) of cases. Age, intraoperative central DM perforation, type 2 bubble formation, and presence of scar in keratoconic and nonkeratoconic corneas were all associated with an increased risk of postoperative double AC formation in the univariate analysis. Manual dissection was not associated with double AC formation. The factors that remained significant in multivariate analysis were keratoconus with scarring (odds ratio [OR] = 3.56, P = .02), non-keratoconus with scarring (OR = 5.09, P = .002), intraoperative central perforation (OR = 6.09, P = .03), and type 2 bubble formation (OR = 14.17, P Conclusions Scarred corneas of both normal and abnormal shape are independent risk factors for double AC formation following DALK, along with intraoperative perforation and the occurrence of a type 2 bubble.
- Published
- 2019
44. Management of Type 2 Bubble Formed During Big-Bubble Deep Anterior Lamellar Keratoplasty
- Author
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Massimo Busin, Asaf Friehmann, Cristina Bovone, Michael Mimouni, and James Myerscough
- Subjects
Ophthalmology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Bubble ,Lamellar keratoplasty ,Medicine ,Socio-culturale ,business ,Corneal transplantation - Published
- 2019
45. Re: Price et al.: Will level 1 evidence trigger a tipping point in endothelial keratoplasty? (Ophthalmology. 2019;126:27-28)
- Author
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James Myerscough and Massimo Busin
- Subjects
Ophthalmology ,business.industry ,Socio-culturale ,Medicine ,Optometry ,business ,Tipping point (climatology) - Published
- 2019
46. Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency
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David P.S. O'Brart, Harry W Roberts, Simone Borsci, Melody Ni, James Myerscough, and Guys & St Thomas NHS Foundation Trust
- Subjects
medicine.medical_specialty ,Operating Rooms ,National Health Programs ,SURGERY ,Operative Time ,Staffing ,Cataract Extraction ,Multiple linear regression model ,Ophthalmology & Optometry ,1117 Public Health and Health Services ,treatment surgery ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Surgical time ,0302 clinical medicine ,Ophthalmology ,Linear regression ,Quantitative assessment ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Duration (project management) ,OUTCOMES ,Science & Technology ,business.industry ,1103 Clinical Sciences ,National health service ,Sensory Systems ,United Kingdom ,1113 Opthalmology and Optometry ,Time and motion ,Time and Motion Studies ,030221 ophthalmology & optometry ,Physical therapy ,business ,Life Sciences & Biomedicine - Abstract
AimTo provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies.MethodsNational Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks.Results140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5–14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons’ time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R2=0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P2=0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs.ConclusionsSignificant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models.
- Published
- 2017
47. Successful Visualization of a Big Bubble during Deep Anterior Lamellar Keratoplasty using Intraoperative OCT
- Author
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James Myerscough, Massimo Busin, Didier Goor, and Asaf Friehmann
- Subjects
Anterior segment optical coherent tomography ,medicine.medical_specialty ,Deep anterior lamellar keratoplasty, Anterior segment optical coherent tomography ,business.industry ,Bubble ,Lamellar keratoplasty ,Deep anterior lamellar keratoplasty ,NO ,Visualization ,Corneal Transplantation ,Ophthalmology ,Surgery, Computer-Assisted ,medicine ,Humans ,business ,Tomography, Optical Coherence - Published
- 2019
48. Diabetic Retinopathy – An Update on Pathophysiology, Classification, Investigation and Treatment
- Author
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ElizabethEmsley, Ganeshan Ramsamy, James Myerscough, Sonia Mall, Vikas Tah, Mandeep Bindra, DarenHanumunthadu, Andrew Swampillai, and Kamran Saha
- Subjects
business.industry ,Medicine ,Diabetic retinopathy ,Bioinformatics ,business ,medicine.disease ,Pathophysiology - Published
- 2014
49. Dry eye — An Insight into Meibomian Gland Dysfunction
- Author
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Vikas Tah, Kamran Saha, James Myerscough, Muhammad Ahad, Jason Ho, Pranev Sharma, Farihah Tariq, and Stephen Tuft
- Subjects
medicine.medical_specialty ,genetic structures ,business.industry ,Ophthalmology ,Meibomian gland dysfunction ,Medicine ,sense organs ,business ,eye diseases - Published
- 2014
50. Estimation of the effects of rounding visual acuity data
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N Andrew Frost, James Myerscough, and Steve Brooks
- Subjects
medicine.medical_specialty ,Visual acuity ,genetic structures ,Databases, Factual ,Visual Acuity ,State Medicine ,Virtual database ,Cellular and Molecular Neuroscience ,Ophthalmology ,Outcome Assessment, Health Care ,Medicine ,Humans ,Analysis method ,Estimation ,business.industry ,Rounding ,Fuchs' Endothelial Dystrophy ,Licensure, Medical ,Snellen visual acuity ,Sensory Systems ,United Kingdom ,Data Interpretation, Statistical ,Optometry ,Observational study ,Clinical Competence ,medicine.symptom ,Outcome data ,business ,Delivery of Health Care ,Descemet Stripping Endothelial Keratoplasty - Abstract
Aims To examine the effect of rounding of visual acuity data on estimates of surgical performance. Method In this observational study, the distribution of 1-year Snellen visual acuity data from 606 endothelial keratoplasties from the NHSBT UK transplant database was analysed. A curve was fitted to the data and used to estimate the frequencies of partly read Snellen lines. The estimates were used to create a virtual database of grafts with Snellen acuities that included individual letter scores. The virtual database was then sampled to produce datasets for 10 virtual surgeons. Various acuity analysis methods were then applied to simulate possible effects of surgeons rounding their data. Results Rounding of acuity data was found to have a notable effect on estimates of surgeons’ success rates. When a criterion of 6/12 or better was applied, the success rates ranged from 62% to 80% using a conservative method of estimation but ranged from 80% to 94% using a less conservative method. Conclusions Rounding of visual acuity scores is an important potential bias in outcome data and should be avoided. If rounding is required we recommend that it is carried out conservatively, giving credit only for lines read completely.
- Published
- 2014
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