PURPOSE: To compare corneal flaps created in rabbits with a 60 kHz femtosecond (FS) laser using different levels of raster energy and to measure early inflammation, corneal stromal cell death, and late postoperative adhesion strength. METHODS: Sixty rabbits were divided into three groups of 20 each. A flap 110 micrometer thick and 9.0 mm in diameter was made in one eye of each rabbit at raster energies of 0.7 microJ, 1.1 microJ, and 2.4 microJ. Histopathological evaluation for inflammation and apoptosis using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed at 4 and 24 hours after flap creation. The adhesion strength of the flaps was measured with a tension meter at 1 and 3 months. RESULTS: Twenty four hours after flap creation, the 2.4 microJ group had more inflammatory and CD11b-positive cells than the 0.7 and 1.1 microJ groups. The number of TUNEL-positive cells increased with raster energy at 4 and 24 hours. The grams of force (gf) needed to detach the flaps at 3 months was significantly higher in 2.4 microJ group (170 gf) than in 0.7 microJ group (97.5 gf) and 1.1 microJ group (100 gf, p = 0.03). CONCLUSIONS: Using raster energy lower than 1.1 microJ to make a flap with a 60 kHz FS laser decreases inflammatory cell infiltration and corneal stromal cell death in the central cornea but may result in a weaker flap than using higher raster energy (2.4 microJ).
Animals ; Cell Death ; Corneal Stroma/*pathology/*surgery ; Keratitis/*pathology/*prevention & control ; Laser Therapy/*methods ; Male ; Models, Animal ; Rabbits ; *Surgical Flaps ; Tissue Adhesions/pathology/surgery

PURPOSE: To compare corneal flaps created in rabbits with a 60 kHz femtosecond (FS) laser using different levels of raster energy and to measure early inflammation, corneal stromal cell death, and late postoperative adhesion strength. METHODS: Sixty rabbits were divided into three groups of 20 each. A flap 110 micrometer thick and 9.0 mm in diameter was made in one eye of each rabbit at raster energies of 0.7 microJ, 1.1 microJ, and 2.4 microJ. Histopathological evaluation for inflammation and apoptosis using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed at 4 and 24 hours after flap creation. The adhesion strength of the flaps was measured with a tension meter at 1 and 3 months. RESULTS: Twenty four hours after flap creation, the 2.4 microJ group had more inflammatory and CD11b-positive cells than the 0.7 and 1.1 microJ groups. The number of TUNEL-positive cells increased with raster energy at 4 and 24 hours. The grams of force (gf) needed to detach the flaps at 3 months was significantly higher in 2.4 microJ group (170 gf) than in 0.7 microJ group (97.5 gf) and 1.1 microJ group (100 gf, p = 0.03). CONCLUSIONS: Using raster energy lower than 1.1 microJ to make a flap with a 60 kHz FS laser decreases inflammatory cell infiltration and corneal stromal cell death in the central cornea but may result in a weaker flap than using higher raster energy (2.4 microJ).
Animals ; Cell Death ; Corneal Stroma/*pathology/*surgery ; Keratitis/*pathology/*prevention & control ; Laser Therapy/*methods ; Male ; Models, Animal ; Rabbits ; *Surgical Flaps ; Tissue Adhesions/pathology/surgery

PURPOSE: To analyze healing changes of corneal wounds of different corneal incision sizes with or without stromal hydration in cataract surgery using anterior segment optical coherence tomography. METHODS: Cataract surgeries were performed by a single surgeon and 2.2- and 2.8-mm corneal incisions were made using a diamond blade (ME-759; Meyco, Biel-Bienne, Swiss). Patients were divided into four groups according to incision size (2.2 and 2.8 mm), and with/without stromal hydration. Fifteen eyes were assigned to each group and incision wounds were measured using anterior segment optical coherence tomography at 2 hours, 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal thickness, incision length and incision angle were measured and existence of epithelial, endothelial gaping and Descemet's membrane detachment was evaluated. RESULTS: Incision thickness was greater in the group with stromal hydration than in the group without on operation day (p < 0.05). Stromal hydration exerted greater influence in the 2.2-mm incision group than in the 2.8-mm incision group. Corneal thickness decreased more rapidly in the stromal hydration group than in the group with no hydration (p = 0.022). Endothelial gaping was greater in the 2.2-mm incision group than in the 2.8-mm incision group 1 day, 1 month, and 3 months after surgery (p = 0.035, p = 0.009, and p = 0.008, respectively). No other statistical significance was observed between the two groups (2.2 and 2.8 mm) during follow-up regarding corneal thickness, epithelial gaping and Descemet's membrane detachment. CONCLUSIONS: Corneal wounds with a smaller incision could be more vulnerable to external stimuli such as stromal hydration and are less stable than those with a larger incision.
Aged ; Anterior Eye Segment ; Cataract Extraction/*methods ; Corneal Stroma/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Surgical Wound Dehiscence/diagnosis/*prevention & control ; Tomography, Optical Coherence/*methods ; *Wound Healing

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 x 82degrees / K2 = 45.88 x 172degrees, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 microm and the other was 150 microm and both were placed at 70degrees. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 x 60degrees) and the keratometric reading (K1 = 50.05 x 93degrees / K2 = 48.83 x 3degrees) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract.
Cataract/*complications/diagnosis ; Corneal Stroma/pathology/*surgery ; Corneal Topography ; Follow-Up Studies ; Humans ; Keratoconus/complications/diagnosis/*surgery ; Lens Implantation, Intraocular/*methods ; Male ; Middle Aged ; Phacoemulsification/*methods ; Severity of Illness Index

PURPOSE: To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases. METHODS: The medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation. RESULTS: All cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK. CONCLUSIONS: DALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.
Adult ; Aged ; Amnion/*transplantation ; Corneal Diseases/pathology/*surgery ; Corneal Stroma/radiation effects/*transplantation ; Female ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; Retrospective Studies ; Visual Acuity ; Young Adult

We report a case of a retained graphite anterior chamber foreign body that was masquerading as stromal keratitis. A 28-year-old male visited with complaints of visual disturbance and hyperemia in his right eye for four weeks. On initial examination, he presented with a stromal edema involving the inferior half of the cornea, epithelial microcysts, and moderate chamber inflammation. Suspecting herpetic stromal keratitis, he was treated with anti-viral and anti-inflammatory agents. One month after the initial visit, anterior chamber inflammation was improved and his visual acuity recovered to 20/20, but subtle corneal edema still remained. On tapering the medication, after three months, a foreign body was incidentally identified in the inferior chamber angle and was surgically removed resulting in complete resolution of corneal edema. The removed foreign body was a fragment of graphite and he subsequently disclosed a trauma with mechanical pencil 12 years earlier. This case showed that the presence of an anterior chamber foreign body should always be considered in the differential diagnosis of idiopathic localized corneal edema.
Adult ; Anterior Chamber/*injuries/pathology ; Corneal Stroma/*pathology ; Diagnosis, Differential ; Eye Foreign Bodies/*diagnosis/physiopathology/surgery ; Eye Injuries, Penetrating/*diagnosis/physiopathology/surgery ; *Graphite ; Humans ; Keratitis/*diagnosis ; Male ; Ophthalmologic Surgical Procedures ; Visual Acuity