1st EuCornea Congress

1st EuCornea Congress venice, 17-19 june 2010
FREE PAPER Abstracts
RESULTS: The penetration rate of riboflavin varied with the type of solution
used. Precisely, - Solution1: 15 minutes after, score 0 (yellow percentage
not more than 20%); 30 minutes after score 2-3 (yellow percentage 75%
-80%); - Solution 2: 30 minutes after score 3-4 (yellow percentage of
79%-84%); - Solution 3: 30 minutes after, score 4-6 (yellow percentage
78%-86%); - Solution 4: 15 minutes after, score 5-6 (yellow percentage
88%-91%); 30 minutes after score 6-7 (yellow percentage over 90%).
CONCLUSIONS: Transepithelial application of riboflavin in association
with other molecules allows a much better diffusion in the corneal stroma
and a passage through the posterior surface, in percentages similar to
those obtained afer de-epithelialisation. This finding allows therapeutic
corneal collagen cross-linking with riboflavin, without the removal of corneal
epithelium.
FINANCIAL DISCLOSURE: 0
Chierego, Chiara
Survival rate of DSAEK with pre-cut cornea
C. Chierego, R. Bellucci
Ophthalmic Unit, Hospital and University of Verona, Verona, Italy
Purpose: To analyze the survival rate of Descemet stripping endothelial
keratoplasty (DSAEK) performed with pre-cut cornea.
Setting: Ophthalmic Unit, Hospital and University of Verona, Italy
Methods: A number of 60 DSAEK procedures performed over a
three-year period and with a minimum follow-up of 6 months have been
considered. Endothelial cell count, graft rejection, reasons for re-grafting
have been considered.
Results: Acute endothelial cell loss was 20-70% according to the
surgeon’s experience and to the use of the Busin glide. Chronic endothelial
cell loss was 4-15% per year, suggesting long term survival in most cases.
No graft rejection occurred. Six eyes underwent surgery repetition, with
good outcome: 5 during the first year and 1 during the second year after
original surgery.
Conclusion: The survival rate of DSAEK with pre-cut cornea is similar to
the rate of DSAEK with home-cut cornea. The advantages of pre-cut tissue
include no postponed surgeries, time save in the operative theatre, surgery
feasibility regardless microkeratome or femtosecond laser availability
Cochener, Beatrice
Management of keratoconus using different
intracorneal rings, femtosecond and cross linking.
B. Cochener, A. Baumann
University of Brest, Brest, France
Purpose: Intracorneal ring segments have demonstrated their interest
for treatment of keratoconus. Nowadays there are two types of intracorneal
ring segments according to their design and biomaterial. We have studied
the efficacy of Keraring © segments compared to Intacs © , both implanted in
a corneal channel made by femtosecond. The surgery was associated to
riboflavine cross-linking in case of young patients with evolutive keratoconus.
The follow up went from 6 to 18 months.
Methods: 51 keratoconic eyes (33 patients) intolerant to contact lenses were
implanted with kerarings (21) or Intacs (12) (number, thickness and arc lengths
were adjusted by specific nomograms according to refraction, localization and
expance of ectasia). 6 patients had a secondary ectasia, none of the eyes
presented abnormality in transparency, and all of them had a pachymetry
over 450µm and at least a visual acuity of 0.4. Riboflavine cross-linking
was performed in 6 young patients with progressive keratoconus. Follow-up
included visual acuity, refraction, elevation and axial topography at 1,3, 6, 12
and 18 months.
Results: Preoperative refractive cylinder was 4,5 D +/- 3, whereas sphere
was 4D +/- 4 . In all cases best corrected visual acuity improved from 1 to
3 lines, with glasses or soft contact lenses (4 cases). Improvement of visual
acuity was even more significant when the cylindrical component was greater
than the spherical. 2 patients unsuccessfully implanted with Intacs © went to a
removal of these rings and benefited from an exchange with kerarings. Optimal
results were obtained between 1 and 3 postoperative months. At the mean
follow up of one year, keratometry appear stable, especially in the cross linking
group. No complication, and no removal of the Kerarings were observed.
Discussion - Conclusion: Intracorneal segments achieved in this study
a very correct efficacy and safety (improved by the use of the femtosecond
for performing the tunnel) when indicated in keratoconus at grade 1 and 2.
Keraring © seem to be of more impact on high irregular astigmatism than
Intacs © , when Intacs © appear to be more efficient in case of associated
myopia. However predictability could be improved. New keraring © segments
with 6mm optical zone instead of 5 mm impose to adjust nomograms but could
improve final outcome.
FINANCIAL DISCLOSURE: 0
Cochener, Beatrice
Osmolarity as a predictive factor for dry eye after
surface photoablation (PRK)
B. Cochener, M. Vanimschoot
University of Brest, Brest, France
Introduction: corneal refractive surgeries acting by section or abrasion
of nerves lead to corneal hypoesthesia inducing a decrease in reflex arc
regulating tears secretion. That could explain postoperative ocular dryness
occurrence. Among parameters of ocular surface evaluation, recent
measure of osmolarity allows a quantification of tear film. It should be
modified in case of hyposecretion or instability. Goal of the study was to
evaluate changes in osmolarity caused by PRK and their potential link to
clinical symptoms.
Methods : 3 months study was conducted on 28 patients (36 eyes)
candidates for PRK , who were assessed preoperatively, then at 1 and 3
month postop. A each visit, 3 tests were performed. Tears osmolarity was
measured using the Tear lab © system, based on the analysis of electrical
impendency from tears sample. 2 others parameters associated Schirmer
and Break U( Time (BUT)
Results : Normal values of osmolarity with TearLab © are range between
275 and 316 mOsm/L ; above we consider that the eye is dry. In our
series we found preoperatively a hyperosmolarity in 22% of patients with
unknown dry eye syndrome before. At 1 month after PRK only 2.5% of
hyperosmolarity was noted probably related to topical tears substitutes
systematically proposed. At 3 months, we observed a normalization of
values in 100% of cases. All patients with preoperative normal rate do not
use artificial tears at one month when those presenting an hyperosmolarity
before PRK spontaneously have continued the treatment up to that time to
normalize osmolarity.
Conclusion: New osmolarity measurement is an easy, fast and non
invasive well tolerated test for detecting (quantitative and/or qualitative)
ocular dryness. It can be for instance integrated in arsenal of tests
performed before corneal surgery in order to detect risk population for
symptomatic postoperative dry eye syndrom that can be source of high
patient discomfort.
FINANCIAL DISCLOSURE: 0
Colabelli, Rossella
A.M. Ultra-thin pre-cut tissue for Descemet’s stripping
automated endothelial keratoplasty: Vision and
endothelial survival
R. Colabelli, D. Amato, C. Amici, R. Donati, L. Greco, C. Villani, A. Pocobelli
S.Giovanni-Addolorata-Britannico Hospital, Rome, Italy
Purpose: To report 15 days and 6 months results using tissue prepared
in eye bank (EB) with a novel preservation medium that significantly
reduces the donor corneal thickness before the microkeratome cut.
Venue: S.Giovanni-Addolorata-Britannico Hospital, Rome,Italy.
Methods: Twenty-one eyes of 21 patients with endothelial dysfunction
due to Fuchs’ endothelial dystrophy and pseudophakic bullous keratopaty
were enrolled in this prospective study performed at S.Giovanni-Addolorata-
Britannico Hospital, Rome, Italy. AS-OCT and confocal microscopy analysis
was performed to analyze the corneal thicknesses, endothelial cellular
morphology and density of donor corneas.
Results: After 7 days the donor tissue thickness decrease was 13% on
average and after 6 months, 30%. Endothelial cell density decreased on
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