Biomedical subjects
Publications and source records attributed to J Frucht-Pery.
Two children with bilateral congenital corneal opacities (sclerocornea) received unilateral corneal transplants at the ages of 4 1/2 and 16 years, respectively. Both developed reading vision and reduced nystagmus excursions.
We performed corneal transplantation in nine microphthalmic eyes of five patients, who ranged in age from 1 to 63 months. The anteroposterior diameter of the eyes ranged from 12.5 to 16 mm. Complications from the surgery included superficial epithelial erosions in three eyes, leading to superficial scarring in one eye, glaucoma, and suture microabscesses. Despite these complications, seven of nine grafts have remained clear and vision developed in all eyes.
PURPOSE: To evaluate the efficacy of topographic measurements for relaxing incisions in astigmatism following penetrating keratoplasty for keratoconus. METHODS: Twenty patients (20 eyes) had relaxing incisions between July 1989 and August 1994 for high astigmatism after penetrating keratoplasty for keratoconus. Ten eyes were evaluated using a HaagStreit keratometer (1989-1991) and 10 eyes were evaluated using EyeSys videokeratography (1991-1994). Relaxing incisions were performed at the steep meridians in the donor/host wound. RESULTS: Mean preoperative astigmatism was 7.75 +/- 2.05 D (range, 4.50 to 12.00 D) for the keratometry group, and 6.49 +/- 3.24 D (range, 1.11 to 10.13 D) for the videokeratography group. Mean astigmatism following relaxing incision was 3.90 +/- 2.02 D (range, 0.93 to 6.50 D) for the keratometry group and 3.06 +/- 1.62 D (range, 0.07 to 5.64 D) for the videokeratography group (no significant difference). Vector analysis revealed a vectorial change of 4.64 +/- 2.54 D for the keratometry group and 4.68 +/- 2.08 D for the videokeratography group (no significant difference). Mean spectacle-corrected visual acuity was significantly improved in the topography-guided group following the procedure (P = .021). Complications included perforations in 3 of 20 eyes. Four patients (4 eyes) in the keratometry group and one patient (1 eye) in the videokeratography group had residual astigmatism greater than 5.00 D. Four patients in the keratometry group needed a second procedure of relaxing incision because of irregular (2 eyes) or high (2 eyes) astigmatism. One patient (1 eye) in the videokeratography group needed a second relaxing incision. CONCLUSIONS: Videokeratography as a guide for relaxing incision has some benefits over standard keratometry. Preoperative evaluation with videokeratography did not significantly improve the postoperative astigmatism. Fewer reoperations were needed when videokeratography was used.
PURPOSE: To evaluate corneal topographic changes after removal of a single interrupted suture in patients who underwent keratoplasty for keratoconus. METHODS: Fifteen interrupted sutures in 15 eyes after keratoplasty were removed to control astigmatism in a prospective clinical study. Videokeratography using an EyeSys Corneal Analysis System was performed before suture removal, and 1 hour, 1 day, 1 week, and 2 to 4 weeks after suture removal. Changes in dioptric power and axis of the steepest and flattest semimeridians were evaluated. RESULTS: The range of the dioptric change of the steepest semimeridian was from -0.43+/-0.34 D during the first hour to +0.70+/-0.39 D from 1 day to 1 week. The largest axis change of the steepest semimeridian (17.1 degrees+/-5.6 degrees, range 1 degree to 66 degrees ) occurred during the first hour (P = .006). The largest surgically induced vectorial change occurred during the first hour (16.10 @ 10.5 ), while relative stability of the steepest semimeridian was observed during the rest of the study period. Changes in power and axis of the flattest semimeridian were also demonstrated. A variety of topographic corneal patterns were demonstrated following suture removal, indicating unpredictable change of astigmatism. CONCLUSIONS: The steepest semimeridian of the central 3-mm zone showed maximal vectorial change 1 hour following suture removal. Reciprocal changes occurred at the same time in the flattest semimeridian. The response of the corneal surface to suture removal is unpredictable and complex.
Radial thermokeratoplasty is a new refractive surgical technique designed to reduce hyperopia and/or astigmatism. Four patients underwent this surgery between February and March 1988 and were monitored postoperatively for the refractive effect and evidence of endothelial cell damage. Immediately following surgery, all eyes were overcorrected, but with time regression of the effect occurred. By 10 to 12 months postoperatively, only 18% of the desired effect remained. No decrease in the central endothelial cell density occurred during this time. Further investigation into the predictability and stability of results is needed to evaluate the long-term effectiveness of this technique.
We studied the complications resulting from using running Mersilene suture in 14 patients who underwent penetrating keratoplasty for keratoconus. 11-0 Mersilene running suture and 12 interrupted 10-0 nylon stitches were used in each procedure and the patients were followed for 22 to 48 months. None of the Mersilene sutures broke, but four were removed in two patients: in one, due to astigmatism or loosening of the suture as a result of sterile ulceration, and in the other, due to herpetic keratitis. Marked scarring manifested along the loops of the sutures in 11 of the Mersilene sutures. Despite these problems, we conclude that the use of Mersilene sutures, alone or combined with nylon sutures, in penetrating keratoplasty is sufficiently advantageous to warrant further study.