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Gottfried O. H. Naumann - One of the best experts on this subject based on the ideXlab platform.
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Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A Prospective Randomized Study Comparing Excimer Laser and Motor Trephination.
Cornea, 2017Co-Authors: Berthold Seitz, Tobias Hager, Achim Langenbucher, Gottfried O. H. NaumannAbstract:PURPOSE We assessed the impact of sequential double running Suture Removal on corneal curvature after penetrating keratoplasty (PK), comparing mechanical and nonmechanical excimer laser trephination. METHODS PK was performed in 134 patients (mean age 51 ± 18 yrs) using either the excimer laser [excimer, n = 60 (37 keratoconus and 23 Fuchs dystrophy)] or motor trephination [control, n = 74 (44 keratoconus and 30 Fuchs dystrophy)] and a double running cross-stitch Suture. Refractometry, Zeiss keratometry, and Tomey corneal topography were performed before Removal of the first Suture (15.2 ± 4.2 mo) and immediately before and at least 6 weeks after Removal of the second Suture (21.4 ± 5.6 mo). RESULTS Keratometry before Removal of the first (-1.7 ± 2.3 D vs. -3.1 ± 2.8 D) and second (-2.3 ± 2.6 D vs. -3.8 ± 2.8 D) Sutures showed that the change in the corneal base curve was significantly smaller in the excimer group than the control group (P < 0.004). After complete Suture Removal, astigmatism decreased in 52% and 11%, remained stable (±0.5 D) in 27% and 9%, and increased in 21% and 80% of eyes in the excimer and control groups, respectively, resulting in significantly lower astigmatism in the excimer (3.1 ± 2.1 D) group compared with the control group (6.2 ± 2.9 D) with "all-Sutures-out" (P < 0.0001). The change in vector-corrected astigmatism (Jaffe) was significantly smaller in the excimer group (4.3 ± 3.5 D) than in the control group (6.9 ± 4.5 D; P < 0.001). CONCLUSIONS In conclusion, less change in astigmatism and the base curve after sequential Removal of a double running Suture indicates better alignment of the graft in the recipient bed after excimer laser trephination. After double running Suture Removal, astigmatism decreases or remains unchanged in 79% of patients after excimer laser keratoplasty and increases in 80% of patients after conventional motor trephination.
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Spontaneous long-term changes of corneal power and astigmatism after Suture Removal after penetrating keratoplasty using a regression model.
American journal of ophthalmology, 2005Co-Authors: Achim Langenbucher, Gottfried O. H. Naumann, Berthold SeitzAbstract:Purpose To assess the diagnosis-based spontaneous long-term changes in corneal power and refraction with a regression model in the all-Sutures-out time period following non-mechanical penetrating keratoplasty (PK). Design Retrospective non-randomized clinical trial. Methods setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after Suture Removal in this retrospective longitudinal study. main outcome measures: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)] were assessed in at least three up to 16 ophthalmologic examinations in the all-Sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval ≥ 12 months) separately for each patient with a linear regression model. Results Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/−0.63 ± 0.46 diopters, P = .02) and an increase/a decrease in TEQ (0.37 ± 0.54/−0.69 ± 0.49 diopters, P = .04) corresponding to a decrease/an increase in SEQ (−0.31 ± 0.47/0.63 ± 0.43 diopters, P = .02). KAST/TAST/RAST showed a minimal annual decrease (−0.06 ± 0.41/−0.05 ± 0.45/−0.06 ± 0.41 diopters) in FD but an increase in KC (0.46 ± 0.41/0.51 ± 0.43/0.46 ± 0.38 diopters) ( P = .05/0.06/0.12). Conclusions In the follow-up after post-keratoplasty Suture Removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after Suture Removal.
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Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts
American journal of ophthalmology, 2005Co-Authors: Nóra Szentmáry, Berthold Seitz, Achim Langenbucher, Gottfried O. H. NaumannAbstract:Purpose To evaluate the functional results of repeat penetrating keratoplasty in clear corneal grafts with high/irregular postkeratoplasty astigmatism. Design Retrospective, longitudinal, single-center, consecutive clinical case series. Methods We studied 17 eyes (16 keratoconus, 1 Fuchs' dystrophy) of 16 patients (age, 54.9 ± 12.6 years). They were treated with repeat PK, performed using the 193-nm Zeiss-Meditec MEL-60 excimer laser using round metal masks (diameter, 7.5–8.0 mm), and employing double running Sutures. main outcome measures: Subjective refractometry, standard keratometry, and corneal topography (Tomey TMS-1) were used to assess best-corrected visual acuity (BCVA), spherical equivalent (SEQ), keratometric and topographic central corneal power (CP), refractive, keratometric and topographic astigmatism, surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) preoperatively, before and after first Suture Removal (1.1 year), and after second Suture Removal (1.8 years). Results Visual acuity improved significantly (BCVA from 0.2–0.5, P = .04 or better) for all postoperative measurements. CP decreased significantly, but SEQ did not change. All measures of astigmatism and SRI and SAI values showed postoperative improvement with Sutures in place; however, astigmatism increased significantly after second Suture Removal. Conclusions With all-Sutures-in, BCVA and astigmatism improve significantly after repeat PK for high/irregular astigmatism. However, to present significant increase in astigmatism, final Suture Removal should be postponed as long as possible in such eyes.
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Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after Suture Removal.
Ophthalmology, 2003Co-Authors: Berthold Seitz, Achim Langenbucher, Michael Küchle, Gottfried O. H. NaumannAbstract:Abstract Objective To assess the impact of graft diameter on corneal curvature before and after Removal of a double-running Suture after nonmechanical penetrating keratoplasty (PK). Design Prospective, nonrandomized, comparative (self-controlled) single-center clinical trial. Patients Four hundred eighty-nine eyes with "two Sutures in" and 308 eyes with "all Sutures out" (mean age, 52±19 years) were included. The diagnoses were keratoconus (48%), Fuchs' and stromal dystrophies (31%), aphakic or pseudophakic bullous keratopathy (11%), and scars (10%). Interventions In all eyes, a central trephination was performed (donor trephination from the epithelial side) using the 193-nm Meditec excimer laser (Carl Zeiss Meditec, Jena, Germany) along metal masks with eight "orientation teeth/notches." Diameters were 8.0 mm, 7.5 mm, and 7.0 mm with a graft oversize of 0.1 mm. In 29% of eyes, additional cataract, intraocular lens surgery, or both were performed simultaneously. In all eyes, a double-running 10-0 nylon Suture was applied. Zeiss keratometry and TMS-1 topography analysis were performed before Removal of the first Suture (14±4 months) and at least 6 weeks after Removal of the second Suture (20±4 months), but before any additional surgery, such as cataract extraction or refractive keratotomies. Main outcome measures Topographic central corneal power (CP; keratometric diopters), keratometric astigmatism (KA), surface regularity index (SRI), and surface asymmetry index (SAI). The regularity of keratometry mires was recorded semiquantitatively from 0=regular to 3=not measurable (as published earlier). Results With both Sutures in, median CP in 7.0-mm (42.0 diopters [D]; P = 0.04) and in 7.5-mm grafts (42.3 D; P = 0.007) was significantly lower than in 8.0-mm grafts (43.0 D). Keratometric astigmatism did not differ between groups (3.0 D vs. 3.0 D vs. 2.7 D). The SRI (1.66 vs. 1.43 vs. 1.11) and SAI (1.55 vs. 1.24 vs. 0.85) decreased significantly with increasing diameter. The proportion of regular keratometry mires (13% vs. 17% vs. 29%) increased, and the proportion of not measurable keratometries (45% vs. 18% vs. 9%) decreased with increasing diameter. With all Sutures out, CP in 7.0-mm grafts (40.4 D) was significantly smaller than in 7.5-mm (43.6 D; P = 0.04) and 8.0-mm grafts (43.3 D; P = 0.04). Again, KA did not differ between groups (3.0 D vs. 3.2 D vs. 3.0 D). The SRI (1.40 vs. 1.09 vs. 0.84) and SAI (1.24 vs. 0.83 vs. 0.62) decreased significantly with increasing diameter. The proportion of regular keratometry mires (5% vs. 31% vs. 52%) increased, and the proportion of not measurable keratometries (42% vs. 11% vs. 4%) decreased with increasing diameter. Conclusions After PK, a smaller graft diameter results in a flatter curvature and a higher degree of topographic irregularity, but not in higher net astigmatism. After Suture Removal, graft topography tends to regularize, whereas the principal differences between diameters do persist.
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nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty1
Ophthalmology, 1999Co-Authors: B Seitz, Achim Langenbucher, Murat M. Kus, Michael Küchle, Gottfried O. H. NaumannAbstract:Abstract Objective To assess the impact of nonmechanical trephination on the outcome after penetrating keratoplasty (PK). Design Prospective, randomized, cross-sectional, clinical, single-center study. Patients A total of 179 eyes of 76 females and 103 males, mean age at the time of surgery 50.6 ± 18.5 (range, 15–83) years. Inclusion criteria were (1) time interval from October 1992 to December 1997; (2) one surgeon (GOHN); (3) primary central PK; (4) Fuchs dystrophy (diameter, 7.5 mm) or keratoconus (diameter, 8.0 mm); (5) graft oversize, 0.1 mm; (6) no previous intraocular surgery; and (7) 16-bite double-running diagonal Suture. Intervention In a randomized fashion, eyes were assigned either to trephination with the 193-nm Meditec excimer laser (manually guided beam in patients, automated rotation device of artificial anterior chamber in donors) along metal masks with eight orientation teeth/notches (EXCIMER: 53 keratoconus, 35 Fuchs dystrophy; mean follow-up, 37 ± 16 months) or with a hand-held motor trephine (Microkeratron; Geuder) (CONTROL: 53 keratoconus, 38 Fuchs dystrophy; mean follow-up, 38 ± 14 months). Subjective refractometry (trial glasses), standard keratometry (Zeiss), and corneal topography analysis (TMS-1; Tomey) were performed before surgery, before Removal of the first Suture (15.2 ± 4.2 months), and after Removal of the second Suture (21.4 ± 5.6 months). Main outcome measures Keratometric and topographic net astigmatism as well as refractive cylinder; keratometric and topographic central power; best-corrected visual acuity (VA); surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) of the TMS-1. Results Before Suture Removal, mean refractive/keratometric/topographic astigmatism did not differ significantly between EXCIMER (2.5 ± 1.8 diopters [D]/3.4 ± 2.8 D/4.7 ± 3.1 D) and CONTROL groups (3.0 ± 1.8 D/3.7 ± 2.4 D/4.3 ± 2.1 D). After Suture Removal, respective values were significantly lower in the EXCIMER group (2.8 ± 2.0 D/ 3.0 ± 2.1 D/3.8 ± 2.6 D) than in the CONTROL group (4.2 ± 2.4 D/ 6.1 ± 2.7 D/6.7 ± 3.1 D) ( P P > 0.05) before surgery, to 20/31 versus 20/38 before ( P = 0.001) and to 20/28 versus 20/39 ( P P = 0.01) and after Suture Removal (−1.4 ± 3.1 D vs. −2.4 ± 3.5 D) ( P = 0.02). Mean SRI ( P = 0.04) and PVA ( P = 0.007) were significantly more favorable in the EXCIMER versus CONTROL group after Suture Removal (0.91 ± 0.45 and 0.82 ± 0.15 vs. 1.05 ± 0.46 and 0.73 ± 0.18). Conclusions Postkeratoplasty results seem to be superior using nonmechanical excimer laser trephination. Thus, this methodology is recommended as the procedure of first choice in avascular corneal pathologies requiring PK.
Berthold Seitz - One of the best experts on this subject based on the ideXlab platform.
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survey of rejection prophylaxis following Suture Removal in penetrating keratoplasty in germany
Klinische Monatsblatter Fur Augenheilkunde, 2021Co-Authors: Sonja Heinzelmann, D Bohringer, Philip Maier, Berthold Seitz, Claus Cursiefen, Annakarina B Maier, Tina Dietrichntoukas, Gerd Geerling, A Viestenz, Norbert PfeifferAbstract:BACKGROUND Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture Removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following Suture Removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. OBJECTIVE The aim of the study was documentation of the variability of medicinal aftercare following Suture Removal in Germany. METHODS Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. RESULTS All centres perform a double-running cross-stitch Suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after Suture Removal. There are differences in intensity (1 - 5 times daily) and tapering (2 - 20 weeks) of the topical steroids following Suture Removal. Two centres additionally use systemic steroids for a few days. DISCUSSION Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following Suture Removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.
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Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A Prospective Randomized Study Comparing Excimer Laser and Motor Trephination.
Cornea, 2017Co-Authors: Berthold Seitz, Tobias Hager, Achim Langenbucher, Gottfried O. H. NaumannAbstract:PURPOSE We assessed the impact of sequential double running Suture Removal on corneal curvature after penetrating keratoplasty (PK), comparing mechanical and nonmechanical excimer laser trephination. METHODS PK was performed in 134 patients (mean age 51 ± 18 yrs) using either the excimer laser [excimer, n = 60 (37 keratoconus and 23 Fuchs dystrophy)] or motor trephination [control, n = 74 (44 keratoconus and 30 Fuchs dystrophy)] and a double running cross-stitch Suture. Refractometry, Zeiss keratometry, and Tomey corneal topography were performed before Removal of the first Suture (15.2 ± 4.2 mo) and immediately before and at least 6 weeks after Removal of the second Suture (21.4 ± 5.6 mo). RESULTS Keratometry before Removal of the first (-1.7 ± 2.3 D vs. -3.1 ± 2.8 D) and second (-2.3 ± 2.6 D vs. -3.8 ± 2.8 D) Sutures showed that the change in the corneal base curve was significantly smaller in the excimer group than the control group (P < 0.004). After complete Suture Removal, astigmatism decreased in 52% and 11%, remained stable (±0.5 D) in 27% and 9%, and increased in 21% and 80% of eyes in the excimer and control groups, respectively, resulting in significantly lower astigmatism in the excimer (3.1 ± 2.1 D) group compared with the control group (6.2 ± 2.9 D) with "all-Sutures-out" (P < 0.0001). The change in vector-corrected astigmatism (Jaffe) was significantly smaller in the excimer group (4.3 ± 3.5 D) than in the control group (6.9 ± 4.5 D; P < 0.001). CONCLUSIONS In conclusion, less change in astigmatism and the base curve after sequential Removal of a double running Suture indicates better alignment of the graft in the recipient bed after excimer laser trephination. After double running Suture Removal, astigmatism decreases or remains unchanged in 79% of patients after excimer laser keratoplasty and increases in 80% of patients after conventional motor trephination.
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Changes in corneal power and refraction due to sequential Suture Removal following nonmechanical penetrating keratoplasty in eyes with keratoconus.
American journal of ophthalmology, 2006Co-Authors: Achim Langenbucher, Berthold SeitzAbstract:Purpose: To assess the changes in corneal power and refraction due to sequential Suture Removal after penetrating keratoplasty (PK). Design Retrospective consecutive case series. Methods setting: Clinical practice. study population: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running Suture) in this longitudinal study. main outcome measures: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equivalent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with Sutures in place (interval 1), with one Suture out (interval 2), and with all Sutures out (interval 3). observation procedure: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages. Results The mean follow-up period was 3.9 ± 1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/TEQ/SEQ changed by 0.64/0.62/−1.11 diopters (interval 1 to interval 2) and by −0.85/−0.90/1.56 diopters (interval 2 to interval 3). Conclusions As a result of Removal of the first running Suture, corneal astigmatism as well as the refractive cylinder tend to oblique axes. As a result of Removal of the second running Suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.
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Spontaneous long-term changes of corneal power and astigmatism after Suture Removal after penetrating keratoplasty using a regression model.
American journal of ophthalmology, 2005Co-Authors: Achim Langenbucher, Gottfried O. H. Naumann, Berthold SeitzAbstract:Purpose To assess the diagnosis-based spontaneous long-term changes in corneal power and refraction with a regression model in the all-Sutures-out time period following non-mechanical penetrating keratoplasty (PK). Design Retrospective non-randomized clinical trial. Methods setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after Suture Removal in this retrospective longitudinal study. main outcome measures: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)] were assessed in at least three up to 16 ophthalmologic examinations in the all-Sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval ≥ 12 months) separately for each patient with a linear regression model. Results Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/−0.63 ± 0.46 diopters, P = .02) and an increase/a decrease in TEQ (0.37 ± 0.54/−0.69 ± 0.49 diopters, P = .04) corresponding to a decrease/an increase in SEQ (−0.31 ± 0.47/0.63 ± 0.43 diopters, P = .02). KAST/TAST/RAST showed a minimal annual decrease (−0.06 ± 0.41/−0.05 ± 0.45/−0.06 ± 0.41 diopters) in FD but an increase in KC (0.46 ± 0.41/0.51 ± 0.43/0.46 ± 0.38 diopters) ( P = .05/0.06/0.12). Conclusions In the follow-up after post-keratoplasty Suture Removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after Suture Removal.
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Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts
American journal of ophthalmology, 2005Co-Authors: Nóra Szentmáry, Berthold Seitz, Achim Langenbucher, Gottfried O. H. NaumannAbstract:Purpose To evaluate the functional results of repeat penetrating keratoplasty in clear corneal grafts with high/irregular postkeratoplasty astigmatism. Design Retrospective, longitudinal, single-center, consecutive clinical case series. Methods We studied 17 eyes (16 keratoconus, 1 Fuchs' dystrophy) of 16 patients (age, 54.9 ± 12.6 years). They were treated with repeat PK, performed using the 193-nm Zeiss-Meditec MEL-60 excimer laser using round metal masks (diameter, 7.5–8.0 mm), and employing double running Sutures. main outcome measures: Subjective refractometry, standard keratometry, and corneal topography (Tomey TMS-1) were used to assess best-corrected visual acuity (BCVA), spherical equivalent (SEQ), keratometric and topographic central corneal power (CP), refractive, keratometric and topographic astigmatism, surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) preoperatively, before and after first Suture Removal (1.1 year), and after second Suture Removal (1.8 years). Results Visual acuity improved significantly (BCVA from 0.2–0.5, P = .04 or better) for all postoperative measurements. CP decreased significantly, but SEQ did not change. All measures of astigmatism and SRI and SAI values showed postoperative improvement with Sutures in place; however, astigmatism increased significantly after second Suture Removal. Conclusions With all-Sutures-in, BCVA and astigmatism improve significantly after repeat PK for high/irregular astigmatism. However, to present significant increase in astigmatism, final Suture Removal should be postponed as long as possible in such eyes.
Achim Langenbucher - One of the best experts on this subject based on the ideXlab platform.
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Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A Prospective Randomized Study Comparing Excimer Laser and Motor Trephination.
Cornea, 2017Co-Authors: Berthold Seitz, Tobias Hager, Achim Langenbucher, Gottfried O. H. NaumannAbstract:PURPOSE We assessed the impact of sequential double running Suture Removal on corneal curvature after penetrating keratoplasty (PK), comparing mechanical and nonmechanical excimer laser trephination. METHODS PK was performed in 134 patients (mean age 51 ± 18 yrs) using either the excimer laser [excimer, n = 60 (37 keratoconus and 23 Fuchs dystrophy)] or motor trephination [control, n = 74 (44 keratoconus and 30 Fuchs dystrophy)] and a double running cross-stitch Suture. Refractometry, Zeiss keratometry, and Tomey corneal topography were performed before Removal of the first Suture (15.2 ± 4.2 mo) and immediately before and at least 6 weeks after Removal of the second Suture (21.4 ± 5.6 mo). RESULTS Keratometry before Removal of the first (-1.7 ± 2.3 D vs. -3.1 ± 2.8 D) and second (-2.3 ± 2.6 D vs. -3.8 ± 2.8 D) Sutures showed that the change in the corneal base curve was significantly smaller in the excimer group than the control group (P < 0.004). After complete Suture Removal, astigmatism decreased in 52% and 11%, remained stable (±0.5 D) in 27% and 9%, and increased in 21% and 80% of eyes in the excimer and control groups, respectively, resulting in significantly lower astigmatism in the excimer (3.1 ± 2.1 D) group compared with the control group (6.2 ± 2.9 D) with "all-Sutures-out" (P < 0.0001). The change in vector-corrected astigmatism (Jaffe) was significantly smaller in the excimer group (4.3 ± 3.5 D) than in the control group (6.9 ± 4.5 D; P < 0.001). CONCLUSIONS In conclusion, less change in astigmatism and the base curve after sequential Removal of a double running Suture indicates better alignment of the graft in the recipient bed after excimer laser trephination. After double running Suture Removal, astigmatism decreases or remains unchanged in 79% of patients after excimer laser keratoplasty and increases in 80% of patients after conventional motor trephination.
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Changes in corneal power and refraction due to sequential Suture Removal following nonmechanical penetrating keratoplasty in eyes with keratoconus.
American journal of ophthalmology, 2006Co-Authors: Achim Langenbucher, Berthold SeitzAbstract:Purpose: To assess the changes in corneal power and refraction due to sequential Suture Removal after penetrating keratoplasty (PK). Design Retrospective consecutive case series. Methods setting: Clinical practice. study population: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running Suture) in this longitudinal study. main outcome measures: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equivalent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with Sutures in place (interval 1), with one Suture out (interval 2), and with all Sutures out (interval 3). observation procedure: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages. Results The mean follow-up period was 3.9 ± 1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/TEQ/SEQ changed by 0.64/0.62/−1.11 diopters (interval 1 to interval 2) and by −0.85/−0.90/1.56 diopters (interval 2 to interval 3). Conclusions As a result of Removal of the first running Suture, corneal astigmatism as well as the refractive cylinder tend to oblique axes. As a result of Removal of the second running Suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.
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Spontaneous long-term changes of corneal power and astigmatism after Suture Removal after penetrating keratoplasty using a regression model.
American journal of ophthalmology, 2005Co-Authors: Achim Langenbucher, Gottfried O. H. Naumann, Berthold SeitzAbstract:Purpose To assess the diagnosis-based spontaneous long-term changes in corneal power and refraction with a regression model in the all-Sutures-out time period following non-mechanical penetrating keratoplasty (PK). Design Retrospective non-randomized clinical trial. Methods setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after Suture Removal in this retrospective longitudinal study. main outcome measures: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)] were assessed in at least three up to 16 ophthalmologic examinations in the all-Sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval ≥ 12 months) separately for each patient with a linear regression model. Results Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/−0.63 ± 0.46 diopters, P = .02) and an increase/a decrease in TEQ (0.37 ± 0.54/−0.69 ± 0.49 diopters, P = .04) corresponding to a decrease/an increase in SEQ (−0.31 ± 0.47/0.63 ± 0.43 diopters, P = .02). KAST/TAST/RAST showed a minimal annual decrease (−0.06 ± 0.41/−0.05 ± 0.45/−0.06 ± 0.41 diopters) in FD but an increase in KC (0.46 ± 0.41/0.51 ± 0.43/0.46 ± 0.38 diopters) ( P = .05/0.06/0.12). Conclusions In the follow-up after post-keratoplasty Suture Removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after Suture Removal.
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Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts
American journal of ophthalmology, 2005Co-Authors: Nóra Szentmáry, Berthold Seitz, Achim Langenbucher, Gottfried O. H. NaumannAbstract:Purpose To evaluate the functional results of repeat penetrating keratoplasty in clear corneal grafts with high/irregular postkeratoplasty astigmatism. Design Retrospective, longitudinal, single-center, consecutive clinical case series. Methods We studied 17 eyes (16 keratoconus, 1 Fuchs' dystrophy) of 16 patients (age, 54.9 ± 12.6 years). They were treated with repeat PK, performed using the 193-nm Zeiss-Meditec MEL-60 excimer laser using round metal masks (diameter, 7.5–8.0 mm), and employing double running Sutures. main outcome measures: Subjective refractometry, standard keratometry, and corneal topography (Tomey TMS-1) were used to assess best-corrected visual acuity (BCVA), spherical equivalent (SEQ), keratometric and topographic central corneal power (CP), refractive, keratometric and topographic astigmatism, surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) preoperatively, before and after first Suture Removal (1.1 year), and after second Suture Removal (1.8 years). Results Visual acuity improved significantly (BCVA from 0.2–0.5, P = .04 or better) for all postoperative measurements. CP decreased significantly, but SEQ did not change. All measures of astigmatism and SRI and SAI values showed postoperative improvement with Sutures in place; however, astigmatism increased significantly after second Suture Removal. Conclusions With all-Sutures-in, BCVA and astigmatism improve significantly after repeat PK for high/irregular astigmatism. However, to present significant increase in astigmatism, final Suture Removal should be postponed as long as possible in such eyes.
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Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after Suture Removal.
Ophthalmology, 2003Co-Authors: Berthold Seitz, Achim Langenbucher, Michael Küchle, Gottfried O. H. NaumannAbstract:Abstract Objective To assess the impact of graft diameter on corneal curvature before and after Removal of a double-running Suture after nonmechanical penetrating keratoplasty (PK). Design Prospective, nonrandomized, comparative (self-controlled) single-center clinical trial. Patients Four hundred eighty-nine eyes with "two Sutures in" and 308 eyes with "all Sutures out" (mean age, 52±19 years) were included. The diagnoses were keratoconus (48%), Fuchs' and stromal dystrophies (31%), aphakic or pseudophakic bullous keratopathy (11%), and scars (10%). Interventions In all eyes, a central trephination was performed (donor trephination from the epithelial side) using the 193-nm Meditec excimer laser (Carl Zeiss Meditec, Jena, Germany) along metal masks with eight "orientation teeth/notches." Diameters were 8.0 mm, 7.5 mm, and 7.0 mm with a graft oversize of 0.1 mm. In 29% of eyes, additional cataract, intraocular lens surgery, or both were performed simultaneously. In all eyes, a double-running 10-0 nylon Suture was applied. Zeiss keratometry and TMS-1 topography analysis were performed before Removal of the first Suture (14±4 months) and at least 6 weeks after Removal of the second Suture (20±4 months), but before any additional surgery, such as cataract extraction or refractive keratotomies. Main outcome measures Topographic central corneal power (CP; keratometric diopters), keratometric astigmatism (KA), surface regularity index (SRI), and surface asymmetry index (SAI). The regularity of keratometry mires was recorded semiquantitatively from 0=regular to 3=not measurable (as published earlier). Results With both Sutures in, median CP in 7.0-mm (42.0 diopters [D]; P = 0.04) and in 7.5-mm grafts (42.3 D; P = 0.007) was significantly lower than in 8.0-mm grafts (43.0 D). Keratometric astigmatism did not differ between groups (3.0 D vs. 3.0 D vs. 2.7 D). The SRI (1.66 vs. 1.43 vs. 1.11) and SAI (1.55 vs. 1.24 vs. 0.85) decreased significantly with increasing diameter. The proportion of regular keratometry mires (13% vs. 17% vs. 29%) increased, and the proportion of not measurable keratometries (45% vs. 18% vs. 9%) decreased with increasing diameter. With all Sutures out, CP in 7.0-mm grafts (40.4 D) was significantly smaller than in 7.5-mm (43.6 D; P = 0.04) and 8.0-mm grafts (43.3 D; P = 0.04). Again, KA did not differ between groups (3.0 D vs. 3.2 D vs. 3.0 D). The SRI (1.40 vs. 1.09 vs. 0.84) and SAI (1.24 vs. 0.83 vs. 0.62) decreased significantly with increasing diameter. The proportion of regular keratometry mires (5% vs. 31% vs. 52%) increased, and the proportion of not measurable keratometries (42% vs. 11% vs. 4%) decreased with increasing diameter. Conclusions After PK, a smaller graft diameter results in a flatter curvature and a higher degree of topographic irregularity, but not in higher net astigmatism. After Suture Removal, graft topography tends to regularize, whereas the principal differences between diameters do persist.
Jeffrey S. Dover - One of the best experts on this subject based on the ideXlab platform.
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clinical effect of a single pulsed dye laser treatment of fresh surgical scars randomized controlled trial
Dermatologic Surgery, 2006Co-Authors: Murad Alam, Sarah Laborde, Kenneth A. Arndt, Michael S. Kaminer, Jeffrey S. DoverAbstract:BACKGROUND Pulsed dye laser has been used to decrease erythema and telangiectasia associated with scars, including surgical scars. There is limited evidence indicating improved surgical scar appearance if pulsed dye laser treatments are commenced immediately at the time of Suture Removal. OBJECTIVE To determine whether a single one-pass pulsed dye laser treatment at the time of Suture Removal can improve the appearance of surgical scars. METHODS Randomized controlled trial enrolling 20 patients (complete data for 17 patients) at two geographic sites, with blinded ratings of pre- and post-treatment photographs obtained at various time points. Included patients underwent elliptical excision for atypical nevi of the trunk and/or extremities, with at least one resulting scar of at least 5 cm in length or two scars of at least 2.5 cm in length. For each patient, each scar or half-scar (if a larger scar was used) was randomized to treatment or control groups. Treatment scars received a single one-pass treatment with a 595 nm pulsed dye laser (Vbeam, Candela Corporation, Wayland, MA, USA) at the time of Suture Removal (ie, 2 weeks after excision) at the following parameters: 7 J/cm2 fluence, 7 mm spot size, 1.5-millisecond pulse duration, and 30-millisecond spray, 20-millisecond delay of dynamic cooling. The treatment area included 1 cm on either side of the scar, and the round laser spots were overlapped 10%. Control scars were not treated with laser. RESULTS Immediate purpura was induced from the laser treatment. Six weeks after laser treatment, no significant difference was found in the clinical appearance of surgical scars treated with a single pulsed dye laser treatment on Suture Removal day versus those surgical scars not treated with laser. Parameters on which no significant difference was found included visibility of incision, erythema, hyperpigmentation, hypopigmentation, induration, and atrophy. Both sets of scars improved over time. CONCLUSIONS A single pulsed dye laser treatment at the time of Suture Removal does not appear to have a beneficial effect on clinical scar appearance. The point of minimal benefit for such laser treatments may lie somewhere between one and three treatments.
Dominik C. Meyer - One of the best experts on this subject based on the ideXlab platform.
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Little benefit of surgical anchor and Suture Removal and of antibiotic therapy beyond 6 weeks in infected rotator cuff repair.
Journal of shoulder and elbow surgery, 2019Co-Authors: Elias Ammann, Ilker Uckay, Samy Bouaicha, Karl Wieser, Dominik C. MeyerAbstract:Background The purpose of this study was to investigate the benefit of surgical anchor and/or Suture Removal and prolonged antibiotic therapy in acute and chronic infections of rotator cuff repair (RCIs). Methods A single-center cohort and case-control study (Cox regression) was performed. Outcome variables were remission of infection and postinfection reoperations due to failed tendon healing for mechanical causes. All analyses were performed with an emphasis on anchor and Suture retention or Removal. Results We identified 54 primary RCIs (44 men; median age 54 years) that were surgically revised (10 by open debridement and 44 by arthroscopy). Twenty-eight (52%) were not intact on revision surgery (debridement) – 10 were partially and 18 totally re-ruptured. The median number of surgical revisions was 1 (range, 1-3), and the median duration of postsurgical antibiotic therapy was 75 days. After a minimal follow-up of 2 years, 8 infections (8/54, 15%) recurred. Twenty patients needed a revision surgery; in all of those 20 patients, intraoperative samples were negative for infection. By multivariate analysis, anchor Removal at the first revision influenced neither remission (hazard ratio [HR] 0.9, 95% confidence interval [CI] 0.4-2.0) nor the need for later revision surgery due to mechanical sequelae (HR 0.6, 95% CI 0.1-1.4). The corresponding HRs for Suture Removal were 0.9 (95% CI 0.4-1.7) and 0.4 (95% CI 0.1-1.2). Likewise, the numbers of revision surgery (HR 0.5, 95% CI 0.2-1.3) and antibiotics beyond 6 weeks failed to influence remission (HR 1.1, 95% CI 0.4-3.1). Conclusions In our RCI cohort, the Removal of anchors or Sutures, repeated revision surgery, or an antibiotic therapy beyond 6 weeks failed to improve remission or to reduce sequelae.
