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Christopher J Rapuano - One of the best experts on this subject based on the ideXlab platform.
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phototherapeutic keratectomy with intraoperative mitomycin c to prevent recurrent anterior Corneal Pathology
American Journal of Ophthalmology, 2006Co-Authors: Brandon D Ayres, Kristin M. Hammersmith, Peter R. Laibson, Christopher J RapuanoAbstract:PURPOSE: To determine the safety and efficacy of the use of intraoperative mitomycin C (MMC) during phototherapeutic keratectomy (PTK) for anterior Corneal disease. DESIGN: Retrospective consecutive case series. METHODS: Retrospective chart review of 13 eyes from 12 patients with various anterior Corneal disorders who had phototherapeutic keratectomy with the use of intraoperative MMC from July 2001 to present. Data on healing time of epithelial defects, complications, and recurrence of disease were recorded. RESULTS: Average time to heal of the epithelial defects was three days, no patient had Corneal or scleral melting, and, as of the printing of this report, no patient has had recurrence of disease in the MMC-treated area. CONCLUSIONS: MMC is safe for intraoperative use during PTK and does not appear to inhibit epithelial healing and may help prevent recurrent anterior Corneal disease.
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excimer laser phototherapeutic keratectomy in eyes with anterior Corneal dystrophies short term clinical outcomes with and without an antihyperopia treatment and poor effectiveness of ultrasound biomicroscopic evaluation
Cornea, 2005Co-Authors: Christopher J RapuanoAbstract:Purpose:To evaluate the use of high-frequency ultrasound biomicroscopy (UBM) in determining the depth of Corneal Pathology in eyes undergoing excimer laser phototherapeutic keratectomy (PTK) for primary or recurrent anterior stromal Corneal dystrophies. Corneal clarity, visual acuity, and refractive
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excimer laser phototherapeutic keratectomy
Current Opinion in Ophthalmology, 2001Co-Authors: Christopher J RapuanoAbstract:: Excimer laser phototherapeutic keratectomy (PTK) is an important tool in the management of superficial Corneal Pathology. It works well in the treatment of anterior Corneal dystrophies and degenerations, but we are learning that it may have a role in the treatment of certain patients with deeper Corneal Pathology. Indications also are being expanded to treat much less common conditions and also to treat children. Irregular astigmatism, which is not treated very well with current PTK techniques, may be addressed better with newer approaches, such as selective zonal ablation and the use of BioMask. As current PTK techniques are improved and newer methods are developed, this procedure will continue to be an excellent option for certain patients with superficial Corneal problems.
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excimer laser phototherapeutic keratectomy long term results and practical considerations
Cornea, 1997Co-Authors: Christopher J RapuanoAbstract:PURPOSE: Our purpose was to evaluate the safety and short- and long-term efficacy of excimer laser phototherapeutic keratectomy (PTK) to treat anterior Corneal Pathology. METHODS: Twenty-eight eyes of 24 patients underwent PTK for anterior Corneal pathologic conditions with a VISX excimer laser. Preoperative indications included granular dystrophy (six eyes), superficial variant of granular dystrophy (six eyes), and Salzmann's nodular degeneration (five eyes). Three eyes had recurrent erosions, and two eyes had keratoconus nodules. Additional diagnoses included other Corneal dystrophies and various Corneal scars. Mean follow-up time was 22.5 months (range, 5-44). One eye underwent a repeated PTK for recurrent scarring 1 year after the initial procedure and is included in the results. RESULTS: The mean time to reepithelialization was 4.2 days (range, 2-11). Corneal smoothness and clarity improved in all patients. Uncorrected visual acuity improved a mean of 1.4 lines (range, -6 to +8 lines) and best corrected visual acuity improved a mean of 2.7 lines (range, -3 to +7 lines). Mean Corneal flattening was 2.13 D (range, 7.75. D flatter to 6.5 D steeper). The preoperative goal was achieved in 22 (78.5%) of 28 eyes, with no significant change in five (18%) eyes and functional worsening in one (3.5%) eye. Five eyes developed moderate to significant recurrences of their Pathology, including the retreated eye. CONCLUSION: Excimer laser PTK is safe and effective for the treatment of anterior Corneal Pathology. Recurrence of Pathology, especially Corneal dystrophies, do occur with time.
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excimer laser phototherapeutic keratectomy
International Ophthalmology Clinics, 1996Co-Authors: Christopher J RapuanoAbstract:Anterior Corneal Pathology, such as Corneal scars and Corneal stromal dystrophies, can be visually devastating. Over the past decade, there was a shift in treatment of these conditions from Corneal transplantation to phototherapeutic keratectomy (PTK) using the 193 nm excimer laser for visual restoration. We have reviewed the recent literature on tech- niques for performing and refining PTK and also on various pathologic conditions that can be treated with PTK. The pri- mary indications for PTK include anterior Corneal dystrophies, such as lattice, granular, and Reis-Buckler's dystrophy. PTK can produce significant visual improvement in these patients, and Corneal transplantation or retransplantation can be de- layed. Corneal degenerations, such as Salzmann's nodular degeneration, keratoconus nodules, and climatic droplet keratopathy, also can be successfully treated with PTK. Addi- tionally, anterior Corneal scars from such etiologies as trauma, Corneal ulcers, and prior refractive surgery can have visual improvement with PTK. In summary, PTK is a powerful tool for the management of anterior Corneal Pathology. In a properly selected and well-counseled patient, PTK can significantly improve vision and quality of life.
Ramon Coral Ghanem - One of the best experts on this subject based on the ideXlab platform.
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pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty results of the first 110 cases
Cornea, 2015Co-Authors: Ramon Coral Ghanem, Ayla Bogoni, Vinicius Coral GhanemAbstract:PURPOSE To report intraoperative and 1-year postoperative results of the pachy-bubble technique for deep anterior lamellar keratoplasty (DALK). METHODS This prospective interventional case series included 110 eyes of 107 patients with anterior Corneal Pathology who underwent DALK, including 78 with keratoconus. Outcome measures included the rate of bubble formation, rate of completing DALK, bubble types, complications, and visual and keratometric parameters. RESULTS Intrastromal air injection was attempted in 109 eyes, and the air bubble was achieved in 93 eyes (85.3%). Intrastromal 2% methylcellulose injection was attempted in 9 eyes, after unsuccessful air bubble formation, and the viscobubble was achieved in 7 eyes (77.8%). Manual layer-by-layer dissection was performed in 8 eyes. Bubble formation was reached in 100 eyes (90.9%). Overall, 105 eyes (95.5%) achieved DALK. Air bubble occurred as type 1 (white margin) in 96.6% of the cases and as type 2 (clear margin) in 3.4%. There was a statistically significant improvement in all visual and keratometric parameters analyzed. Macroperforations converted to penetrating keratoplasty occurred in 5 eyes (4.5%) and microperforations in 12 (10.9%). There were significantly higher rates of perforation when a bubble was not achieved (P = 0.018) and when it was achieved as type 2 (P = 0.033). Interface haze occurred in 5 eyes (4.5%) and stromal rejection in 11 (10.0%). A short learning curve was observed for air bubble formation. CONCLUSIONS Bubble formation, especially type 1, is the key to decrease the risk of perforation in DALK. The pachy-bubble was safe, effective, and reproducible in promoting DALK with air bubble and viscobubble formation with a short learning curve.
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pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty
Cornea, 2012Co-Authors: Ramon Coral Ghanem, Marcielle A GhanemAbstract:To evaluate an innovative technique for intrastromal air injection to achieve deep anterior lamellar keratoplasty (DALK) with bare Descemet membrane (DM). Thirty-four eyes with anterior Corneal Pathology, including 27 with keratoconus, underwent DALK. After 400 μm trephination with a suction trephine, ultrasound pachymetry was performed 0.8 mm internally from the trephination groove in the 11 to 1 o'clock position. In this area, a 2-mm incision was created, parallel to the groove, with a micrometer diamond knife calibrated to 90% depth of the thinnest measurement. A cannula was inserted through the incision and 0.5 mL of air was injected to dissect the DM from the stroma. After peripheral paracentesis, anterior keratectomy was carried out to bare the DM. A 0.25-mm oversized graft was sutured in place. Overall, 94.1% of eyes achieved DALK. Bare DM was achieved in 30 eyes, and a pre-DM dissection was performed in 2 eyes. Air injection was successful in detaching the DM (achieving the big bubble) in 88.2% of the eyes. In keratoconus eyes, the rate was 88.9%. All cases but one required a single air injection to achieve DM detachment. Microperforations occurred in 5 cases: 3 during manual layer-by-layer dissection after air injection failed to detach the DM, 1 during removal of the residual stroma after big-bubble formation, and 1 during the diamond knife incision. Two cases (5.9%) were converted to penetrating keratoplasty because of macroperforations. The technique was reproducible, safe, and highly effective in promoting DALK with bare DM.
Nermien Salah Eldien Mohammed Elhaddad - One of the best experts on this subject based on the ideXlab platform.
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the impact of nd yag laser posterior capsulotomy by the use of the circular pattern with vitreous strand cut technique on anterior chamber parameters
Lasers in Medical Science, 2019Co-Authors: Nermien Salah Eldien Mohammed ElhaddadAbstract:AIM: The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology. METHODS: This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, Corneal Pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment Pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central Corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500 mm (AOD500), AOD at 750 mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally. RESULTS: The mean patient age was 55.56 ± 6.33 years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all. CONCLUSION: Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.
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the impact of nd yag laser posterior capsulotomy by the use of the circular pattern with vitreous strand cut technique on anterior chamber parameters
Lasers in Medical Science, 2019Co-Authors: Nermien Salah Eldien Mohammed ElhaddadAbstract:AIM: The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology. METHODS: This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, Corneal Pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment Pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central Corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500 mm (AOD500), AOD at 750 mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally. RESULTS: The mean patient age was 55.56 ± 6.33 years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all. CONCLUSION: Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.
Marcielle A Ghanem - One of the best experts on this subject based on the ideXlab platform.
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pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty
Cornea, 2012Co-Authors: Ramon Coral Ghanem, Marcielle A GhanemAbstract:To evaluate an innovative technique for intrastromal air injection to achieve deep anterior lamellar keratoplasty (DALK) with bare Descemet membrane (DM). Thirty-four eyes with anterior Corneal Pathology, including 27 with keratoconus, underwent DALK. After 400 μm trephination with a suction trephine, ultrasound pachymetry was performed 0.8 mm internally from the trephination groove in the 11 to 1 o'clock position. In this area, a 2-mm incision was created, parallel to the groove, with a micrometer diamond knife calibrated to 90% depth of the thinnest measurement. A cannula was inserted through the incision and 0.5 mL of air was injected to dissect the DM from the stroma. After peripheral paracentesis, anterior keratectomy was carried out to bare the DM. A 0.25-mm oversized graft was sutured in place. Overall, 94.1% of eyes achieved DALK. Bare DM was achieved in 30 eyes, and a pre-DM dissection was performed in 2 eyes. Air injection was successful in detaching the DM (achieving the big bubble) in 88.2% of the eyes. In keratoconus eyes, the rate was 88.9%. All cases but one required a single air injection to achieve DM detachment. Microperforations occurred in 5 cases: 3 during manual layer-by-layer dissection after air injection failed to detach the DM, 1 during removal of the residual stroma after big-bubble formation, and 1 during the diamond knife incision. Two cases (5.9%) were converted to penetrating keratoplasty because of macroperforations. The technique was reproducible, safe, and highly effective in promoting DALK with bare DM.
Vinicius Coral Ghanem - One of the best experts on this subject based on the ideXlab platform.
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pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty results of the first 110 cases
Cornea, 2015Co-Authors: Ramon Coral Ghanem, Ayla Bogoni, Vinicius Coral GhanemAbstract:PURPOSE To report intraoperative and 1-year postoperative results of the pachy-bubble technique for deep anterior lamellar keratoplasty (DALK). METHODS This prospective interventional case series included 110 eyes of 107 patients with anterior Corneal Pathology who underwent DALK, including 78 with keratoconus. Outcome measures included the rate of bubble formation, rate of completing DALK, bubble types, complications, and visual and keratometric parameters. RESULTS Intrastromal air injection was attempted in 109 eyes, and the air bubble was achieved in 93 eyes (85.3%). Intrastromal 2% methylcellulose injection was attempted in 9 eyes, after unsuccessful air bubble formation, and the viscobubble was achieved in 7 eyes (77.8%). Manual layer-by-layer dissection was performed in 8 eyes. Bubble formation was reached in 100 eyes (90.9%). Overall, 105 eyes (95.5%) achieved DALK. Air bubble occurred as type 1 (white margin) in 96.6% of the cases and as type 2 (clear margin) in 3.4%. There was a statistically significant improvement in all visual and keratometric parameters analyzed. Macroperforations converted to penetrating keratoplasty occurred in 5 eyes (4.5%) and microperforations in 12 (10.9%). There were significantly higher rates of perforation when a bubble was not achieved (P = 0.018) and when it was achieved as type 2 (P = 0.033). Interface haze occurred in 5 eyes (4.5%) and stromal rejection in 11 (10.0%). A short learning curve was observed for air bubble formation. CONCLUSIONS Bubble formation, especially type 1, is the key to decrease the risk of perforation in DALK. The pachy-bubble was safe, effective, and reproducible in promoting DALK with air bubble and viscobubble formation with a short learning curve.