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Rahul Pandey - One of the best experts on this subject based on the ideXlab platform.

  • application of the smile derived glued lenticule patch graft in Microperforations and partial thickness corneal defects
    Cornea, 2016
    Co-Authors: Vipul Bhandari, Sri Ganesh, Sheetal Brar, Rahul Pandey
    Abstract:

    To report the initial clinical outcomes of the small incision lenticule extraction (SMILE)-derived glued lenticule patch graft for management of Microperforations and complicated corneal tears.In this single-center case series, 7 eyes (of 7 patients) that presented with Microperforations, partial-thickness corneal defect, and traumatic complicated corneal tear were repaired with a lenticule patch graft obtained from Refractive Lenticule Extraction (ReLEx) with the SMILE procedure. The patch was secured to the recipient eye using fibrin glue. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the defect and to decide the thickness of the lenticule. Patients were followed up on days 1, 7, and 15 and at 1 and 3 months postoperatively. Main outcome parameters measured were best-corrected visual acuity, clarity of the graft, and restoration of optical and tectonic integrity.All surgeries were uneventful. Significant improvement in visual acuity was seen from 15 days onward in 5 of 7 eyes. The lenticule graft was well apposed and remained clear until the last follow-up visit in all eyes treated.The patch graft from the SMILE-derived lenticule using fibrin glue seems to serve as a safe, feasible, and inexpensive surgical option for the management of Microperforations and complicated corneal tears, especially in centers that perform the SMILE procedure in large numbers.

  • Application of the SMILE-Derived Glued Lenticule Patch Graft in Microperforations and Partial-Thickness Corneal Defects.
    Cornea, 2016
    Co-Authors: Vipul Bhandari, Sri Ganesh, Sheetal Brar, Rahul Pandey
    Abstract:

    PURPOSE To report the initial clinical outcomes of the small incision lenticule extraction (SMILE)-derived glued lenticule patch graft for management of Microperforations and complicated corneal tears. METHODS In this single-center case series, 7 eyes (of 7 patients) that presented with Microperforations, partial-thickness corneal defect, and traumatic complicated corneal tear were repaired with a lenticule patch graft obtained from Refractive Lenticule Extraction (ReLEx) with the SMILE procedure. The patch was secured to the recipient eye using fibrin glue. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the defect and to decide the thickness of the lenticule. Patients were followed up on days 1, 7, and 15 and at 1 and 3 months postoperatively. Main outcome parameters measured were best-corrected visual acuity, clarity of the graft, and restoration of optical and tectonic integrity. RESULTS All surgeries were uneventful. Significant improvement in visual acuity was seen from 15 days onward in 5 of 7 eyes. The lenticule graft was well apposed and remained clear until the last follow-up visit in all eyes treated. CONCLUSIONS The patch graft from the SMILE-derived lenticule using fibrin glue seems to serve as a safe, feasible, and inexpensive surgical option for the management of Microperforations and complicated corneal tears, especially in centers that perform the SMILE procedure in large numbers.

Ramon Coral Ghanem - One of the best experts on this subject based on the ideXlab platform.

  • Late Detachment after DALK in a Patient with Descemet Membrane Microperforation
    Ophthalmology @ Point of Care, 2017
    Co-Authors: Marilia Lordello Passos, Vinicius Coral Ghanem, Andre L Piccinini, Ramon Coral Ghanem
    Abstract:

    We report a case of late detachment in a patient with Descemet membrane (DM) microperforation following a deep anterior lamellar keratoplasty (DALK). Late detachment of the DM in this case occurred...

  • pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty results of the first 110 cases
    Cornea, 2015
    Co-Authors: Ramon Coral Ghanem, Ayla Bogoni, Vinicius Coral Ghanem
    Abstract:

    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.

  • pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty
    Cornea, 2012
    Co-Authors: Ramon Coral Ghanem, Marcielle A Ghanem
    Abstract:

    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.

Vipul Bhandari - One of the best experts on this subject based on the ideXlab platform.

  • application of the smile derived glued lenticule patch graft in Microperforations and partial thickness corneal defects
    Cornea, 2016
    Co-Authors: Vipul Bhandari, Sri Ganesh, Sheetal Brar, Rahul Pandey
    Abstract:

    To report the initial clinical outcomes of the small incision lenticule extraction (SMILE)-derived glued lenticule patch graft for management of Microperforations and complicated corneal tears.In this single-center case series, 7 eyes (of 7 patients) that presented with Microperforations, partial-thickness corneal defect, and traumatic complicated corneal tear were repaired with a lenticule patch graft obtained from Refractive Lenticule Extraction (ReLEx) with the SMILE procedure. The patch was secured to the recipient eye using fibrin glue. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the defect and to decide the thickness of the lenticule. Patients were followed up on days 1, 7, and 15 and at 1 and 3 months postoperatively. Main outcome parameters measured were best-corrected visual acuity, clarity of the graft, and restoration of optical and tectonic integrity.All surgeries were uneventful. Significant improvement in visual acuity was seen from 15 days onward in 5 of 7 eyes. The lenticule graft was well apposed and remained clear until the last follow-up visit in all eyes treated.The patch graft from the SMILE-derived lenticule using fibrin glue seems to serve as a safe, feasible, and inexpensive surgical option for the management of Microperforations and complicated corneal tears, especially in centers that perform the SMILE procedure in large numbers.

  • Application of the SMILE-Derived Glued Lenticule Patch Graft in Microperforations and Partial-Thickness Corneal Defects.
    Cornea, 2016
    Co-Authors: Vipul Bhandari, Sri Ganesh, Sheetal Brar, Rahul Pandey
    Abstract:

    PURPOSE To report the initial clinical outcomes of the small incision lenticule extraction (SMILE)-derived glued lenticule patch graft for management of Microperforations and complicated corneal tears. METHODS In this single-center case series, 7 eyes (of 7 patients) that presented with Microperforations, partial-thickness corneal defect, and traumatic complicated corneal tear were repaired with a lenticule patch graft obtained from Refractive Lenticule Extraction (ReLEx) with the SMILE procedure. The patch was secured to the recipient eye using fibrin glue. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the defect and to decide the thickness of the lenticule. Patients were followed up on days 1, 7, and 15 and at 1 and 3 months postoperatively. Main outcome parameters measured were best-corrected visual acuity, clarity of the graft, and restoration of optical and tectonic integrity. RESULTS All surgeries were uneventful. Significant improvement in visual acuity was seen from 15 days onward in 5 of 7 eyes. The lenticule graft was well apposed and remained clear until the last follow-up visit in all eyes treated. CONCLUSIONS The patch graft from the SMILE-derived lenticule using fibrin glue seems to serve as a safe, feasible, and inexpensive surgical option for the management of Microperforations and complicated corneal tears, especially in centers that perform the SMILE procedure in large numbers.

Marcielle A Ghanem - One of the best experts on this subject based on the ideXlab platform.

  • pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty
    Cornea, 2012
    Co-Authors: Ramon Coral Ghanem, Marcielle A Ghanem
    Abstract:

    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.

  • Late Detachment after DALK in a Patient with Descemet Membrane Microperforation
    Ophthalmology @ Point of Care, 2017
    Co-Authors: Marilia Lordello Passos, Vinicius Coral Ghanem, Andre L Piccinini, Ramon Coral Ghanem
    Abstract:

    We report a case of late detachment in a patient with Descemet membrane (DM) microperforation following a deep anterior lamellar keratoplasty (DALK). Late detachment of the DM in this case occurred...

  • pachymetry guided intrastromal air injection pachy bubble for deep anterior lamellar keratoplasty results of the first 110 cases
    Cornea, 2015
    Co-Authors: Ramon Coral Ghanem, Ayla Bogoni, Vinicius Coral Ghanem
    Abstract:

    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.