Skip to content
6CCVD Research

Quintuple Procedure for Ocular Surface Reconstruction and Visual Rehabilitation

At a Glance

Section titled ā€œAt a Glanceā€
MetadataDetails
Publication Date2023-08-21
JournalCornea
AuthorsJuan Carlos Navia, Piero Carletti, Matthew Camacho, Sander R. Dubovy, Jaime D. Martinez
InstitutionsUniversity of Miami

Abstract

Section titled ā€œAbstractā€

Purpose: The aim of this study was to describe a combined surgical approach for ocular surface and visual rehabilitation in patients with limbal stem cell deficiency, corneal scarring, and cataract. We aimed to introduce this combined approach as an alternative to a staged approach and to describe the intraoperative use of a diamond ophthalmic burr (DOB) and optical coherence tomography (OCT) to achieve and confirm a smooth graft-host interface during the anterior lamellar keratoplasty (ALK) portion of the procedure. Methods: The quintuple procedure described herein consists of a modified ALK, cataract extraction, intraocular lens implantation, simple limbal epithelial transplantation, and temporal tarsorrhaphy. Intraoperative OCT and DOB were used to guide the creation of the stromal bed during the ALK. The procedure was performed in a patient with limbal stem cell deficiency and corneal scarring after a chemical ocular burn. Results: The tarsorrhaphy was removed at 3 months postoperatively once complete corneal epithelialization was observed. The best-corrected visual acuity improved from light perception preoperatively to 20/30 at 16 months postoperatively with the use of scleral contact lenses. At this postoperative time point, the cornea was clear and compact, and the ocular surface was stable. Conclusions: The quintuple procedure allowed for visual and ocular surface rehabilitation in cases in which follow-up for a staged approach was not possible. Intraoperative OCT allowed for real-time visualization and dissection of the stromal bed, whereas the use of the DOB helped achieve a smooth stromal surface for an optimal graft-host interface.

Tech Support

Section titled ā€œTech Supportā€

Original Source

Section titled ā€œOriginal Sourceā€

References

Section titled ā€œReferencesā€
  1. 2022 - A review of the diagnosis and treatment of limbal stem cell deficiency [Crossref]
  2. 2022 - Deep anterior lamellar keratoplasty: current status and future directions [Crossref]
  3. 2012 - Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency [Crossref]
  4. 2012 - In vivo confocal microscopic findings in patients with limbal stem cell deficiency [Crossref]
  5. 2021 - Long-term review of penetrating keratoplasty: a 20-year review in Asian eyes [Crossref]
  6. 2005 - Deep anterior lamellar keratoplasty combined with autologous limbal stem cell transplantation in unilateral severe chemical injury [Crossref]
  7. 2011 - Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the American Academy of Ophthalmology [Crossref]
  8. 2020 - Burr-assisted anterior lamellar keratoplasty (DALK) in patients with corneal stromal scarring: a case series [Crossref]

Reads Similar to This

Diamond burr debridement of 34 canine corneas with presumed corneal calcareous degeneration Fast and Sensitive Detection of Paramagnetic Species Using Coupled Charge and Spin Dynamics in Strongly Fluorescent Nanodiamonds NV-plasmonics - modifying optical emission of an NVāˆ’ center via plasmonic metal nanoparticles