Cornea - ARVO

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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaPurpose: The aim of this study was to compare the clinical outcomeof regrafts with first grafts.Methods: Two-year outcome data were obtained from the SwedishCornea Transplant Register for patients undergoing penetratingkeratoplasty (PK) between 2001and 2008. The survival and visualoutcome of regrafts with the original diagnoses of keratoconus,Fuchs’ endothelial dystrophy (FED) or bullous keratopathy (BK)were compared with first grafts for the same diagnoses by univariateand logistic regression methods.Results: The failure rate for grafts in keratoconus increased threefoldin regrafts compared with first grafts (i.e., 17% vs. 6%, p=0.002)doubled in FED regrafts (33% vs. 15%, p=0.001). In BK, the failurerate was already high in first grafts and the increase in failure ofregrafts was minimal (p=0.9). Visual acuity was also worse inregrafts compared to first grafts, mainly in the keratoconus and FEDpatients. In the keratoconus group, visual acuity with preferredcorrection was ≥0.5 in 69% of first grafts compared with only 55% inregrafts (p=001). In FED 52% of first grafts but only 19% of regraftsachieved VA ≥0.5, (p=0.001). The visual outcome of regrafts in BKwas poor but little different from first grafts where fewer than 20%achieved VA ≥0.5.Conclusions: This analysis confirmed the poorer survival of regraftswhere the original indication was keratoconus or FED. In addition,visual outcome was also worse than in first grafts. However, theoutcomes for regrafts in BK were similar to first grafts.Commercial Relationships: Margareta Claesson, None; JohnArmitage, NoneSupport: Sahlgrenska University research grantProgram Number: 3100 Poster Board Number: D0035Presentation Time: 8:30 AM - 10:15 AMFemtosecond Laser "Mini-Bubble" Deep Lamellar Dissection forDALK and DSAEKRoger F. Steinert, Marjan Farid, Sumit Garg, Matthew Wade.Ophthalmology, Gavin Herbert Eye Institute, UC Irvine, Irvine, CA.Purpose: To better define the parameters of femtosecond laser deepanterior lamellar dissection that result in a smooth bed for either deepanterior lamellar keratoplasty (DALK) or for preparation of donormaterial in thin stroma descemet stripping automated endothelialkeratoplasty (DSAEK)Methods: 10 fresh human corneal scleral donors were mounted onartificial anterior chambers and exposed to femtosecond laserdissections 30-50 microns anterior to Descemet membrane using aniFS 150 kHz laser (Abbott Medical Optics, Santa Ana, CA).Variables studied were spot separation, pattern of laser scanning, andpulse energy. Key outcomes were 1) ease of tissue separation; 2)gross inspection of the tissue bed; 3) spectral domain opticalcoherence tomography (OCT); and 4) trypan blue/alizarin redstaining of the endothelium.Results: Separation of the tissue plane was easiest with acombination of close spot separation (4x4 microns) and high pulseenergy (3.5 microjoules). The smoothest bed was obtained with widepulse spacing (10x10 microns); low pulse energy just higher thanthreshold (0.4 5 to 0.6 microjoules) and 8 alternating raster and spiralpasses, rotated 45 degrees between each pair of passes. OCT revealedstromal separation either at or slightly anterior to Descemetmembrane. Staining showed no evidence of endothelial injury.Conclusions: Wide pulse spacing and very low pulse energydelivered in multiple passes results in a smoother stromal plane in thedeep cornea, compared to tight spot spacing and higher pulse energylevels. This "mini-bubble" technique may be useful in both DALKand in donor tissue preparation for DSAEK.Commercial Relationships: Roger F. Steinert, Abbott MedicalOptics (C), OptiMedica (C), ReVision Optics (C), WaveTec (C);Marjan Farid, None; Sumit Garg, None; Matthew Wade, NoneSupport: Departmental development grant, Research to PreventBlindness; Discovery Eye FoundationProgram Number: 3101 Poster Board Number: D0036Presentation Time: 8:30 AM - 10:15 AMCorneal thickness after posterior lamellar keratoplastyAnders Ivarsen, Jesper Hjortdal, Nicolaj Aagaard, J.ChristianHedegaard, Henrik Sejersen, Christina Møller. Ophthalmology,Aarhus University Hospital, Aarhus, Denmark.Purpose: Descemet’s stripping automated keratoplasty (DSAEK) hasbecome the most frequently performed treatment for visuallysignificant endothelial dystrophy. The surgery causes a transientincrease in recipient corneal hydration; however, it remains unknownwhether structural changes in the recipient cornea also occur.Methods: Seventy-six patients treated for endothelial dystrophy werefollowed with routine clinical examination for at least one year afterDSAEK. At all visits, central corneal thickness (CCT) wasdetermined with a Haag-Streit optical pachymeter. The difference inCCT from 3 days to 1 year after sugery (ΔCCT = CCT 3days -CCT 1year ) was calculated as a crude measure of postoperative cornealedema. At their latest visit, patients were examined with spectraldomain OCT (SD-OCT; Heidelberg Spectralis with anterior segmentmodule) to determine the central thickness of the recipient cornea(recipient corneal thickness; RCT). SD-OCT was also used todetermine CCT in a group of normal corneas.Results: From 1 to 6 years after DSAEK, RCT averaged 490 ± 29μm, which was significantly less than the CCT of 531 ± 18 μm thatwas observed with SD-OCT in normal corneas (p < 0.001). RCTmeasured 487 ± 28 μm after one year (n = 43), 491 ± 29 μm after 2years (n = 24), and 505 ± 26 μm after 3 to 6 years (n = 9), with aslight but significant increase over time (Pearson’s corr; r 2 = 0.06; p =0.03). Correlating RCT with ΔCCT also showed a significantcorrelation between postoperative corneal edema and RCT, withmore edema causing the recipient cornea to become thinner over time(r 2 = 0.11; p = 0.006).Conclusions: In patients treated with DSAEK for endothelialdystrophy we found corneas to be thinner than normal once thepostoperative edema had resolved.The correlation between postoperativeedema and RCT may suggest that wash-out of stromalground substances induce the thinning, with the subsequent gradualincrease in thickness being caused by resynthesis of extracellularmaterial. However, the long-lasting nature of the observed changescould also suggest underlying structural abnormalities in endothelialdystrophy.Commercial Relationships: Anders Ivarsen, None; JesperHjortdal, Carl Zeiss Meditec (R); Nicolaj Aagaard, None;J.Christian Hedegaard, None; Henrik Sejersen, None; ChristinaMøller, None323 Corneal Surgery RefractiveTuesday, May 07, 2013 8:30 AM-10:15 AMExhibit Hall Poster SessionProgram #/Board # Range: 3102-3147/D0037-D0082Organizing Section: CorneaProgram Number: 3102 Poster Board Number: D0037Presentation Time: 8:30 AM - 10:15 AMRole of Subconjunctival Bevacizumab in Post-PterygiumExcision Management©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaSonia B. Dhoot 1 , Howard Guan 2 , Keith Tokuhara 3 . 1 Ophthalmology,University of Missouri Kansas City, Kansas City, MO;2 Ophthalmology, Loma Linda Medical Center, Loma Linda, CA;3 Ophthalmology, Arrowhead Regional Medical Center, Colton, CA.Purpose: The exact pathogenesis of pterygium formation isunknown, but previous research has demonstrated that variousgrowth factors, including VEGF, may play a role. The use of VEGFinhibitors bevacizumab and ranibizumab is poorly understood ininhibiting pterygium growth. The objective of this study was tocompare the effects of wound healing and recurrence rates inpostoperative bevacizumab versus pterygium excision alone.Methods: This was a prospective trial. Thirty-one patients with aprimary pterygium of at least 2 mm in size and without any previousocular surgery were included. Seventeen patients received 5mgpostoperative bevacizumab on postoperative weeks two and six,while fourteen patients received no bevacizumab. Outcome measuresincluded best corrected visual acuity, intraocular pressure, recurrence,and any sight threatening complications at two weeks, two months,and six months postoperatively.Results: Six patients were lost to follow-up, four of which wereassigned to the bevacizumab group. Of the remaining thirteenpatients in the bevacizumab group, four had recurrence of thepterygium (30.7%). Two of the remaining twelve in the control grouphad a recurrence (16.7%).Conclusions: Bevacizumab does not improve recurrence rates forpterygia when used as an adjunctive therapy postoperatively. It mayeven cause increased rates of recurrence, although further studies areneeded before arriving at this conclusion.Figure 1. A. Preoperative photograph of a 4mm nasal pterygium ofthe left eye. B. Recurrence of pterygium 2 months after surgery in apatient who received postoperative bevacizumab.Figure 1. A. Preoperative photograph of a 4mm nasal pterygium ofthe left eye. B. Recurrence of pterygium 2 months after surgery in apatient who received postoperative bevacizumab.Commercial Relationships: Sonia B. Dhoot, None; Howard Guan,None; Keith Tokuhara, NoneClinical Trial: NCT01736449Program Number: 3103 Poster Board Number: D0038Presentation Time: 8:30 AM - 10:15 AMThe effect of pterygium surgery on corneal astigmatismClinton J. Duncan, Sarah Logan, Kent L. Anderson. Ophthalmology,University of Texas Health Science Center at San Antonio, SanAntonio, TX.Purpose: Quantify the effect pterygium surgery has on cornealastigmatism and identify factors that may predispose patients to havelesser or greater astigmatism after pterygium surgery. Calculate thesuccess rate of pterygium surgery by looking at recurrence rate andidentify those factors predisposing to recurrence.Methods: An IRB approved retrospective chart review of all TexasDiabetes Institute (TDI) patients that underwent pterygium surgery atthe University Hospital System (UHS) and the Medical Arts andResearch Center (MARC) over a 3 year period was completed. Sex,age, race, and pterygium details including eye (left vs right), side(nasal vs temporal), primary vs recurrent, and size were analyzed.Surgery details including duration, surgical technique, medications(pre-, intra-, post-), surgeon(s), and site were also included inanalysis. Pre- and post-operative simulated topography and refractionwere compared to determine statistical significance. Factorsassociated with changes in astigmatism and recurrence rates wereanalyzed.Results: Review and analysis was completed on records from 92eyes from 82 patients. The total mean pre-operative (3.46, S.D. 0.62)and mean post-operative (1.99, S.D. 1.85) simulated cornealastigmatism values were significantly different (P
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