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Jeffrey M. Ketcham - One of the best experts on this subject based on the ideXlab platform.

  • Clinical and anatomical study of the effect of transscleral fixation of Posterior Chamber Lenses on early postkeratoplasty astigmatism.
    Cornea, 1993
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson, Anthony Evangelista, Jeffrey M. Ketcham
    Abstract:

    We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured Posterior Chamber Lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism oriented perpendicularly to the haptics of the TSPCL. Twenty-seven patients (37%) had an orientation of astigmatism that was in the same meridian of the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the TSPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the Lens fixated within 0.75 mm of the limbus were more likely to have astigmatism oriented perpendicular to the meridian of the haptics of the Posterior Chamber Lens in the early postoperative period. Patients having the Lens fixated 2-3 mm Posterior to the limbus were more likely to have astigmatism oriented in the same meridian as the haptics of the Posterior Chamber Lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplasty, the placement of a Posterior Chamber Lens with haptics fixated within 0.75 mm of the limbus significantly widens the recipient bed an average of 0.3 mm in the meridian of the haptics of Lens placement (p = 0.02). When the Posterior Chamber Lens haptics were fixated 3 mm Posterior to the limbus, the recipient bed was significantly narrowed in the meridian of Lens placement an average of 0.2 mm (p = 0.02). It appears that the TSPCLs may have an effect on early postkeratoplasty astigmatism by distorting the corneal wound at the time of keratoplasty.

  • Penetrating keratoplasty and transscleral fixation of Posterior Chamber Lens.
    American journal of ophthalmology, 1992
    Co-Authors: Edward J. Holland, Donald J. Doughman, Sheraz M. Daya, Anthony Evangelista, Jeffrey M. Ketcham, Anthony J. Lubniewski, Stephen S. Lane
    Abstract:

    We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a Posterior Chamber Lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed Lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these, 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a Posterior Chamber Lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular Lens implantation with absent capsular support.

Amiram Shapiro - One of the best experts on this subject based on the ideXlab platform.

  • External Transscleral Posterior Chamber Lens Fixation-Reply
    Archives of Ophthalmology, 1992
    Co-Authors: Martha Motuz Leen, Amiram Shapiro
    Abstract:

    In Reply. —We appreciate Dr Friedlander's interesting and practical suggestions. In procedures described in our article and elsewhere 1 for external transscleral Posterior Chamber Lens fixation, tying a 10-0 polypropylene suture to the Lens haptic may indeed be a difficult maneuver for several reasons. As the polypropylene suture is tied to the Lens haptic, the knot may easily slip off the haptic. We have found that a Lens recently released by Alcon (Model CZ70BD, Fort Worth, Tex) has holes positioned within the haptics at an optimal site for suture Lens fixation, and avoids the problem of knot slippage. The residents in our teaching program have found this Lens much easier to use. This Lens is also 12.5 mm in length, an ideal length for sulcus placement. As pointed out by Dr Friedlander, tying a one-ended suture may also be challenging. Our technique describes the use of a double-armed polypropylene suture

  • External transscleral Posterior Chamber Lens fixation.
    Archives of ophthalmology (Chicago Ill. : 1960), 1991
    Co-Authors: Amiram Shapiro, Martha Motuz Leen
    Abstract:

    To avoid the complications associated with anterior Chamber intraocular Lenses and iris-fixated Posterior Chamber Lenses when challenged with inadequate capsular or zonular support, we have developed a new method of measured external transscleral suture fixation of Posterior Chamber intraocular Lenses within the ciliary sulcus. This technique differs from most current techniques of transscleral fixation, which involve passing needles through the corneoscleral wound into the ciliary sulcus without direct visualization and out through the sclera. Our technique offers a more predictable placement of suture within the ciliary sulcus and avoids damage to corneal endothelium, ciliary body, or other ocular structures.

Edward J. Holland - One of the best experts on this subject based on the ideXlab platform.

  • Clinical and anatomical study of the effect of transscleral fixation of Posterior Chamber Lenses on early postkeratoplasty astigmatism.
    Cornea, 1993
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson, Anthony Evangelista, Jeffrey M. Ketcham
    Abstract:

    We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured Posterior Chamber Lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism oriented perpendicularly to the haptics of the TSPCL. Twenty-seven patients (37%) had an orientation of astigmatism that was in the same meridian of the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the TSPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the Lens fixated within 0.75 mm of the limbus were more likely to have astigmatism oriented perpendicular to the meridian of the haptics of the Posterior Chamber Lens in the early postoperative period. Patients having the Lens fixated 2-3 mm Posterior to the limbus were more likely to have astigmatism oriented in the same meridian as the haptics of the Posterior Chamber Lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplasty, the placement of a Posterior Chamber Lens with haptics fixated within 0.75 mm of the limbus significantly widens the recipient bed an average of 0.3 mm in the meridian of the haptics of Lens placement (p = 0.02). When the Posterior Chamber Lens haptics were fixated 3 mm Posterior to the limbus, the recipient bed was significantly narrowed in the meridian of Lens placement an average of 0.2 mm (p = 0.02). It appears that the TSPCLs may have an effect on early postkeratoplasty astigmatism by distorting the corneal wound at the time of keratoplasty.

  • Penetrating keratoplasty and transscleral fixation of Posterior Chamber Lens.
    American journal of ophthalmology, 1992
    Co-Authors: Edward J. Holland, Donald J. Doughman, Sheraz M. Daya, Anthony Evangelista, Jeffrey M. Ketcham, Anthony J. Lubniewski, Stephen S. Lane
    Abstract:

    We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a Posterior Chamber Lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed Lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these, 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a Posterior Chamber Lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular Lens implantation with absent capsular support.

  • Early postkeratoplasty astigmatism following placement of anterior Chamber Lenses and transsclerally sutured Posterior Chamber Lenses.
    The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists Inc, 1992
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson
    Abstract:

    Intraocular pseudophakic correction during penetrating keratoplasty (PK) for aphakic or pseudophakic bullous keratopathy may be achieved either with anterior or Posterior Chamber Lenses. Posterior Chamber Lenses can be fixed to the iris or sclera in eyes lacking adequate Posterior capsular support. Post-PK astigmatism can delay early visual rehabilitation of the patient. We reviewed the last 15 patients at our institution who had undergone PK and anterior Chamber Lens placement for bullous keratopathy. These were compared to the last 15 patients who had undergone PK and transsclerally sutured Posterior Chamber Lens placement. Patients who had placement of a flexible anterior Chamber Lens at time of PK had a mean astigmatism of 6.73 D at the last visit before any sutures were removed. There was no predominant axis of astigmatism or relationship of the axis of astigmatism to the meridian of Lens placement. Patients with placement of a transsclerally sutured Posterior Chamber Lens at time of PK had a mean astigmatism of 5.18 D at the last visit before any sutures were removed. Mean astigmatism was not significantly different (P greater than 0.05) from that seen with anterior Chamber Lens placement. In the majority of patients the axis of post-PK astigmatism was oriented perpendicular to the meridian of the transsclerally sutured Posterior Chamber Lens.

Donald J. Doughman - One of the best experts on this subject based on the ideXlab platform.

  • Clinical and anatomical study of the effect of transscleral fixation of Posterior Chamber Lenses on early postkeratoplasty astigmatism.
    Cornea, 1993
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson, Anthony Evangelista, Jeffrey M. Ketcham
    Abstract:

    We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured Posterior Chamber Lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism oriented perpendicularly to the haptics of the TSPCL. Twenty-seven patients (37%) had an orientation of astigmatism that was in the same meridian of the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the TSPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the Lens fixated within 0.75 mm of the limbus were more likely to have astigmatism oriented perpendicular to the meridian of the haptics of the Posterior Chamber Lens in the early postoperative period. Patients having the Lens fixated 2-3 mm Posterior to the limbus were more likely to have astigmatism oriented in the same meridian as the haptics of the Posterior Chamber Lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplasty, the placement of a Posterior Chamber Lens with haptics fixated within 0.75 mm of the limbus significantly widens the recipient bed an average of 0.3 mm in the meridian of the haptics of Lens placement (p = 0.02). When the Posterior Chamber Lens haptics were fixated 3 mm Posterior to the limbus, the recipient bed was significantly narrowed in the meridian of Lens placement an average of 0.2 mm (p = 0.02). It appears that the TSPCLs may have an effect on early postkeratoplasty astigmatism by distorting the corneal wound at the time of keratoplasty.

  • Penetrating keratoplasty and transscleral fixation of Posterior Chamber Lens.
    American journal of ophthalmology, 1992
    Co-Authors: Edward J. Holland, Donald J. Doughman, Sheraz M. Daya, Anthony Evangelista, Jeffrey M. Ketcham, Anthony J. Lubniewski, Stephen S. Lane
    Abstract:

    We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a Posterior Chamber Lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed Lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these, 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a Posterior Chamber Lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular Lens implantation with absent capsular support.

  • Early postkeratoplasty astigmatism following placement of anterior Chamber Lenses and transsclerally sutured Posterior Chamber Lenses.
    The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists Inc, 1992
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson
    Abstract:

    Intraocular pseudophakic correction during penetrating keratoplasty (PK) for aphakic or pseudophakic bullous keratopathy may be achieved either with anterior or Posterior Chamber Lenses. Posterior Chamber Lenses can be fixed to the iris or sclera in eyes lacking adequate Posterior capsular support. Post-PK astigmatism can delay early visual rehabilitation of the patient. We reviewed the last 15 patients at our institution who had undergone PK and anterior Chamber Lens placement for bullous keratopathy. These were compared to the last 15 patients who had undergone PK and transsclerally sutured Posterior Chamber Lens placement. Patients who had placement of a flexible anterior Chamber Lens at time of PK had a mean astigmatism of 6.73 D at the last visit before any sutures were removed. There was no predominant axis of astigmatism or relationship of the axis of astigmatism to the meridian of Lens placement. Patients with placement of a transsclerally sutured Posterior Chamber Lens at time of PK had a mean astigmatism of 5.18 D at the last visit before any sutures were removed. Mean astigmatism was not significantly different (P greater than 0.05) from that seen with anterior Chamber Lens placement. In the majority of patients the axis of post-PK astigmatism was oriented perpendicular to the meridian of the transsclerally sutured Posterior Chamber Lens.

Anthony Evangelista - One of the best experts on this subject based on the ideXlab platform.

  • Clinical and anatomical study of the effect of transscleral fixation of Posterior Chamber Lenses on early postkeratoplasty astigmatism.
    Cornea, 1993
    Co-Authors: David R. Hardten, Edward J. Holland, Donald J. Doughman, J. D. Nelson, Anthony Evangelista, Jeffrey M. Ketcham
    Abstract:

    We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured Posterior Chamber Lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism oriented perpendicularly to the haptics of the TSPCL. Twenty-seven patients (37%) had an orientation of astigmatism that was in the same meridian of the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the TSPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the Lens fixated within 0.75 mm of the limbus were more likely to have astigmatism oriented perpendicular to the meridian of the haptics of the Posterior Chamber Lens in the early postoperative period. Patients having the Lens fixated 2-3 mm Posterior to the limbus were more likely to have astigmatism oriented in the same meridian as the haptics of the Posterior Chamber Lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplasty, the placement of a Posterior Chamber Lens with haptics fixated within 0.75 mm of the limbus significantly widens the recipient bed an average of 0.3 mm in the meridian of the haptics of Lens placement (p = 0.02). When the Posterior Chamber Lens haptics were fixated 3 mm Posterior to the limbus, the recipient bed was significantly narrowed in the meridian of Lens placement an average of 0.2 mm (p = 0.02). It appears that the TSPCLs may have an effect on early postkeratoplasty astigmatism by distorting the corneal wound at the time of keratoplasty.

  • Penetrating keratoplasty and transscleral fixation of Posterior Chamber Lens.
    American journal of ophthalmology, 1992
    Co-Authors: Edward J. Holland, Donald J. Doughman, Sheraz M. Daya, Anthony Evangelista, Jeffrey M. Ketcham, Anthony J. Lubniewski, Stephen S. Lane
    Abstract:

    We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a Posterior Chamber Lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed Lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these, 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a Posterior Chamber Lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular Lens implantation with absent capsular support.