Dataset Information

Case series: Use of stromal lenticule as patch graft.

ABSTRACT: Purpose:To introduce cases of the use, as patch grafts, of stromal lenticules obtained by small incision lenticule extraction (SMILE) surgery. Observations:Case 1 was a 79-year-old man who presented with Ahmed-valve-tube exposure in his left eye. His uncorrected visual acuity (UCVA) was 20/40, best-corrected visual acuity (BCVA) 20/32, and intraocular pressure (IOP) 11?mmHg. He was treated with stromal lenticule patch that had been extracted by SMILE surgery. The patch was positioned underneath of the conjunctiva and sutured to it. At postoperative 8 months, the graft site was well maintained without Ahmed valve-tube exposure, the UCVA was 20/32, BCVA 20/20, and IOP 12?mmHg.Case 2 was a 60-year-old man who presented with Ahmed-valve-tube exposure in his right eye. His UCVA was finger-count (FC) 30 cm, his BCVA 20/125, and his IOP 14?mmHg. He was treated with stromal lenticule patch by the same method as employed in case 1. At postoperative 10 days, tube re-exposure and displacement of the Ahmed valve external plate toward the limbus area occurred due to loosening of the anchoring suture. So, we removed the Ahmed valve device, which had been implanted in the supero-temporal area, and performed new Ahmed valve implantation, with a stromal lenticule flap instead of a partial scleral flap, in the supero-nasal area. As of 6 months post-reoperation, the patient was stable, with UCVA 20/200, BCVA 20/40 and IOP 13?mmHg.Case 3 was a 74-year-old man who presented with bullous keratopathy in his right eye, which was blind. Due to severe adhesions, his conjunctiva could not cover the entire cornea. Therefore, we performed a stromal lenticule patch graft with conjunctival advance flap. At postoperative 3 months, the patient's right eye was stable, without displacement or melting of the lenticule graft. Conclusions & importance:It is suggested that the stromal lenticule, with its biocompatibility, sufficient strength, ease of handling and low cost, is a useful patch graft for various therapeutic purposes in the ophthalmic field.

SUBMITTER: Song YJ

PROVIDER: S-EPMC6174828 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

Case series: Use of stromal lenticule as patch graft.

Song Yong Ju YJ Kim Sumi S Yoon Gil Joong GJ

American journal of ophthalmology case reports 20180927

<h4>Purpose</h4>To introduce cases of the use, as patch grafts, of stromal lenticules obtained by small incision lenticule extraction (SMILE) surgery.<h4>Observations</h4>Case 1 was a 79-year-old man who presented with Ahmed-valve-tube exposure in his left eye. His uncorrected visual acuity (UCVA) was 20/40, best-corrected visual acuity (BCVA) 20/32, and intraocular pressure (IOP) 11 mmHg. He was treated with stromal lenticule patch that had been extracted by SMILE surgery. The patch was positio ...[more]

PMID: 30302418

Similar Datasets

Project description:PurposeThe purpose of this study was to explore the optimal shape of customized lenticules for stromal lenticule addition keratoplasty (SLAK) for off-centered ectasia.MethodsTwo different methods to create ex vivo models of eccentric-keratoconus were investigated. Twelve human corneas were used to create model 1 by a hyperopic photorefractive keratectomy (PRK), and model 2 by masked phototherapeutic keratectomy (PTK) on the anterior corneal surface, whereas both types received myopic ablation of the posterior surface. Keratoconus models underwent a modified femtosecond laser (FSL) flap-cut to create stromal pockets. Sixteen human corneas underwent FSL dissection to obtain four lenticule types: type I (planar) and type II (negative) lenticules were used without modifications, whereas type III (customized-planar), and type IV (customized-negative) lenticules underwent further masked-PRK to obtain an asymmetric bow-tie shape. Topographic, aberrometric analysis, and anterior segment optical coherence tomography (AS-OCT) were performed in all recipient corneas before and after lenticule implantation.ResultsKeratoconus model was successfully reproduced. Tomographic analysis showed a significant inferiorly decentered corneal steepening with coherent stromal thinning. Model 2 reproduced better the curvature of real keratoconus. Lenticules type I implantation induced a homogeneous corneal thickening, type III produced higher thickening in the inferior half of the cornea. Type II determined a maximal peripheral pachymetric increase, with a gradual reduction toward the center, and type IV presented an asymmetric peripheral thickening. Topographic assessment showed a cone apex flattening in all cases, but it was significantly higher in types II and IV. Customized lenticules improved significantly corneal surface regularity regarding types I and II.ConclusionsThe approach of customizing lenticules by increasing their asymmetry and tailoring the re-shaping effects, may improve SLAK outcomes in eccentric keratoconus.

Project description:Background:This study aims to examine the outcome of simultaneous maxillary sinus lifting, bone grafting, and vertical ridge augmentation through retrospective studies. Methods:From 2005 to 2010, patients with exhibited severe alveolar bone loss received simultaneous sinus lifting, bone grafting, and vertical ridge augmentations were selected. Fifteen patients who visited in Seoul National University Bundang Hospital were analyzed according to clinical records and radiography. Postoperative complications; success and survival rate of implants; complications of prosthesis; implant stability quotient (ISQ); vertical resorption of grafted bone after 1, 2, and 3 years after surgery; and final observation and marginal bone loss were evaluated. Results:The average age of the patients was 54.2 years. Among the 33 implants, six failed to survive and succeed, resulting in an 81.8% survival rate and an 81.8% success rate. Postoperative complications were characterized by eight cases of ecchymosis, four cases of exposure of the titanium mesh or membrane, three cases of peri-implantitis, three cases of hematoma, two cases of sinusitis, two cases of fixture fracture, one case of bleeding, one case of numbness, one case of trismus, and one case of fixture loss. Prosthetic complications involved two instances of screw loosening, one case of abutment fracture, and one case of food impaction. Resorption of grafted bone material was 0.23 mm after 1 year, 0.47 mm after 2 years, 0.41 mm after 3 years, and 0.37 mm at the final observation. Loss of marginal bone was 0.12 mm after 1 year, and 0.20 mm at final observation. Conclusions:When sinus lifting, bone grafting, and vertical ridge augmentation were performed simultaneously, postoperative complications increased, and survival rates were lower. For positive long-term prognosis, it is recommended that a sufficient recovery period be needed before implant placement to ensure good bone formation, and implant placement be delayed.

Project description:IntroductionRefractive stromal lenticules from Small Incision Lenticule Extraction (SMILE), though usually discarded, hold a potential for various ophthalmic applications, including refractive correction, stromal volume expansion, and biomechanical strengthening of the cornea.ObjectivesTo investigate the effect of lenticule customization on lenticule neurite length profile and the excitatory response (calcium signaling) and the potential of reinnervation.MethodsHuman and porcine stromal lenticules were treated by (1) excimer laser reshaping, (2) ultraviolet A-riboflavin crosslinking (CXL), and (3) decellularization by sodium dodecyl sulfate (SDS), respectively. The overall neurite scaffold immuno-positive to TuJ1 (neuron-specific class III β-tubulin) expression and population of active neurite fragments with calcium response revealed by L-glutamate-induced Fluo-4-acetoxymethyl ester reaction were captured by wide-field laser-scanning confocal microscopy, followed by z-stack image construction. The NeuronJ plugin was used to measure neurite lengths for TuJ1 (NL-TuJ1) and calcium signal (NL-Ca). Reinnervation of lenticules was examined by the ex vivo grafting of chick dorsal root ganglia (DRG) to the decellularized human lenticules. Differences between groups and controls were analyzed with ANOVA and Mann-Whitney U test.ResultsThe customization methods significantly eliminated neurites inside the lenticules. NL-TuJ1 was significantly reduced by 84% after excimer laser reshaping, 54% after CXL, and 96% after decellularization. The neurite remnants from reshaping and CXL exhibited calcium signaling, indicative of residual excitatory response. Re-innervation occurred in the decellularized lenticules upon stimulation of the grafted chick embryo DRG with nerve growth factor (NGF 2.5S).ConclusionAll of the lenticule customization procedures reduced lenticule neurites, but the residual neurites still showed excitatory potential. Even though these neurite remnants seemed minimal, they could be advantageous to reinnervation with axon growth and guidance after lenticule reimplantation for refractive and volume restoration of the cornea.

Dataset Information

Case series: Use of stromal lenticule as patch graft.

Publications

Case series: Use of stromal lenticule as patch graft.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets