Advances In Medical And Surgical Cornea: From Diagnosis To Procedure (essentials In Ophthalmology)

This book presents up-to-date information on the diagnosis and management of the spectrum of medical and surgical corneal diseases, with a special focus on new technology. The latest tools for diagnosing ocular surface disease, infectious keratitis, and ocular allergies are discussed, along with novel treatment options for these entities. The impact of progress in imaging and contact lens technology on the management of corneal conditions is fully described, and the efficacy of corneal collagen crosslinking for keratoconus and corneal ectasia is evaluated. Detailed attention is devoted to the latest surgical techniques, including lamellar keratoplasty, endothelial keratoplasty, keratoprosthesis, and laser-assisted penetrating keratoplasty. In addition, the role of the eye bank in facilitating corneal procedures is explained. Advances in Medical and Surgical Cornea is written by leading authorities who share a passion for effective, cutting-edge care. It will be invaluable for both experienced ophthalmologists and trainees. -- Publisher Preface 6 Contents 8 1: Diagnosis and Management of Ocular Surface Disease 9 1.1 Introduction 9 1.2 Diagnosing Dry Eye Syndrome 9 1.3 Treating Dry Eye Syndrome 13 1.3.1 Ocular Surface Protection 13 1.3.2 Treating Inflammation 13 1.3.3 Punctal Occlusion 14 1.3.4 Treating Lid Disease 14 1.3.5 Nutritional Considerations 15 1.3.6 Recalcitrant Dry Eye Syndrome 16 Conclusions 16 References 17 2: Advances in the Diagnosis and Management of Infectious Keratitis 19 2.1 Introduction 19 2.2 Diagnosis 20 2.2.1 Bacteria 20 2.2.2 Fungi 22 2.2.3 Virus 23 2.2.4 Parasitic 24 2.2.5 Corneal Imaging and Corneal Biopsy 25 2.2.6 Molecular Diagnosis 26 2.3 Management 26 2.3.1 Bacteria 27 2.3.2 Fungi 27 2.3.3 Virus 29 2.3.4 Parasitic 30 Conclusions 31 References 32 3: Allergic Disease of the Eye 35 3.1 Introduction 35 3.2 Allergic Conjunctivitis: Seasonal/Perennial 35 3.2.1 Historical Perspective 35 3.2.2 Epidemiology 35 3.2.3 Clinical Features 36 3.2.4 Patient Evaluation, Diagnosis, and Differential Diagnosis 37 3.2.5 Treatment 38 3.3 Atopic Keratoconjunctivitis 40 3.3.1 Historical Perspective 40 3.3.2 Epidemiology 40 3.3.3 Clinical Features 40 3.3.4 Patient Evaluation, Diagnosis, and Differential Diagnosis 41 3.3.5 Treatment 41 3.4 Vernal Keratoconjunctivitis 42 3.4.1 Historical Perspective 42 3.4.2 Epidemiology 42 3.4.3 Clinical Features 43 3.4.4 Patient Evaluation, Diagnosis, and Differential Diagnosis 43 3.4.5 Treatment 44 3.5 Giant Papillary Conjunctivitis 45 3.5.1 Historical Perspective 45 3.5.2 Epidemiology 45 3.5.3 Clinical Features 45 3.5.4 Patient Evaluation, Diagnosis, and Differential Diagnosis 45 3.5.5 Treatment 46 3.6 Conjunctival Provocation Testing 46 3.7 Contact Dermatitis (Fig. 3.5) 47 3.7.1 Epidemiology 47 3.7.2 Clinical Features 48 3.7.3 Patient Evaluation, Diagnosis, and Differential Diagnosis 48 3.7.4 Treatment 48 Conclusions 48 References 49 4: Imaging Techniques for Corneal Disorders 52 4.1 Introduction 52 4.2 Confocal Microscopy 52 4.2.1 Function 52 4.2.2 Normal Anatomy 53 4.2.3 Clinical Uses 53 4.3 Specular Microscopy 56 4.3.1 Normal Anatomy 56 4.3.2 Clinical Uses 57 4.4 Anterior Segment Optical Coherence Tomography 58 4.4.1 Function 58 4.4.2 Clinical Uses 59 4.4.3 AS-OCT Versus UBM 59 Conclusions 59 References 60 5: Advances in Contact Lens for the Treatment of Ocular Surface Disease and the Corneal Ectasias 63 5.1 Contact Lens for the Treatment of Ocular Surface Disease 63 5.1.1 Soft Lens for Ocular Surface Disease 63 5.1.2 Rigid Lens for Ocular Surface Disease 65 5.1.3 PROSE Treatment for Ocular Surface Disease 65 5.2 Recent Advances: Ocular Surface Disease 66 5.2.1 Soft Lens 66 5.2.2 Rigid Gas-Permeable Scleral Lenses 67 5.2.3 PROSE Treatment for Ocular Surface Disease 67 5.3 Contact Lens for the Treatment of Corneal Ectasia 69 5.4 Recent Advances: Corneal Ectasia 70 5.4.1 Soft Lens 70 5.4.2 Rigid Gas-Permeable Corneal Lenses 70 5.4.3 Piggyback Systems 70 5.4.4 Hybrid Lenses 71 5.4.5 RGP Mini-scleral and Scleral Lens 71 5.4.6 PROSE Treatment 71 5.5 Future Innovations 73 Conclusions 73 References 73 6: Corneal Collagen Cross-Linking for Keratoconus and Corneal Ectasia 76 6.1 Introduction 76 6.2 Pathophysiology 76 6.2.1 The Cross-Linking Procedure 77 6.3 Clinical Outcomes 77 6.3.1 Visual Acuity and Refractive Outcomes 77 6.3.2 Topographic Outcomes 78 6.3.3 Topographic Keratoconus Indices 79 6.3.4 Higher-Order Aberrations 80 6.3.5 Patient Satisfaction 82 6.3.6 Postoperative Timecourse 82 6.4 Biomechanical Changes 83 6.5 Complications 84 6.5.1 Postoperative Haze 84 6.5.2 Corneal Pachymetry 85 6.6 Predictors of Outcomes 87 6.7 Future of Corneal Collagen Cross-Linking 89 Conclusions 90 References 90 7: Advancements in Anterior Lamellar Keratoplasty 93 7.1 Introduction 93 7.2 Indications 94 7.3 Donor Tissue Selection 94 7.4 Anesthesia Planning 94 7.5 Surgical Procedures 94 7.5.1 Superficial Anterior Lamellar Keratoplasty 94 7.5.2 Manual Dissection 94 7.5.3 Microkeratome-Assisted Superficial ALK 95 7.5.4 Sutureless Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty 95 7.6 Deep Anterior Lamellar Keratoplasty 96 7.6.1 Manual Dissection 96 7.6.2 Melles Technique 96 7.6.3 Anwar’s Big-Bubble Technique 98 7.6.4 Femtosecond Laser-Assisted Deep Lamellar Anterior Keratoplasty 99 7.7 Technique 99 7.8 Outcomes 100 7.9 Surgical Complications and Management 100 Conclusion 101 References 101 8: Endothelial Keratoplasty 103 8.1 History, Innovations, and Terminology 103 8.2 Surgical Techniques 105 8.2.1 DLEK 105 8.2.2 DSEK 106 8.2.3 DMEK 109 8.2.4 Hybrid Techniques 109 8.2.5 Ultrathin DSAEK 110 8.3 Surgical Considerations with Ocular Comorbidities 110 8.3.1 Aphakic Eyes with Complete or Partial Aniridia 110 8.3.2 Phakic Eyes 111 8.3.3 Prior Glaucoma Filtering/Tube Surgery 111 8.3.4 Vitrectomized Eyes 111 8.3.5 Failed Prior PK 111 8.3.6 Iridocorneal Endothelial (ICE) Syndrome 112 8.3.7 Pediatric Endothelial Keratoplasty 112 8.4 Surgical Outcomes 112 8.4.1 Visual Acuity 112 8.4.2 Refractive Results 113 8.4.3 Endothelial Cell Loss 113 8.4.4 Graft Survival 113 8.5 Complications 113 8.5.1 Early Postoperative Raised IOP 113 8.5.2 Graft Detachment (Fig. 8.5, First Row) 113 8.5.3 Primary Graft Failure 114 8.5.4 Immunologic Rejection (Fig. 8.5, Third Row) 115 8.5.5 Glaucoma 115 8.5.6 Epithelial Downgrowth (Fig. 8.5, Second Row, Fourth) 115 8.5.7 Interface Abnormalities 115 8.5.8 Infections 115 8.6 Future Prospects 115 Conclusions 116 References 116 9: Boston Keratoprosthesis 119 9.1 Introduction 119 9.2 Indications 119 9.3 Design 120 9.4 Surgical Procedure 120 9.5 Intraoperative Complications 122 9.6 Postoperative Management 122 9.7 Visual Acuity Outcomes 123 9.8 Postoperative Complications 124 9.9 Future of Keratoprosthesis 124 Conclusions 125 References 125 10: Laser-Assisted Keratoplasty and Post-keratoplasty Management 127 10.1 Introduction 127 10.2 Femtosecond Lasers in Ophthalmology 127 10.3 The Femtosecond 128 10.4 Patient Selection and Evaluation 129 10.5 Tissue Preparation and Surgical Procedure 130 10.6 Literature Review of Femtosecond Keratoplasty 131 10.6.1 FLEK 131 10.6.2 Femtosecond Laser-Enabled Lamellar Keratoplasty 132 10.6.3 Deep Anterior Lamellar Keratoplasty 132 10.6.4 Anterior Lamellar Keratoplasty 132 10.6.5 Endothelial Keratoplasty 132 10.6.6 Pediatric Keratoplasty 133 10.6.7 Post-keratoplasty Management 133 10.7 Femtosecond Incisions for Correction of Post-­keratoplastic Astigmatism 134 Conclusions 134 References 134 11: Eye Banking: What the Eye Bank Can Do for You Now 137 Conclusions 145 References 145 Front Matter....Pages i-vii Diagnosis and Management of Ocular Surface Disease....Pages 1-10 Advances in the Diagnosis and Management of Infectious Keratitis....Pages 11-26 Allergic Disease of the Eye....Pages 27-43 Imaging Techniques for Corneal Disorders....Pages 45-55 Advances in Contact Lens for the Treatment of Ocular Surface Disease and the Corneal Ectasias....Pages 57-69 Corneal Collagen Cross-Linking for Keratoconus and Corneal Ectasia....Pages 71-87 Advancements in Anterior Lamellar Keratoplasty....Pages 89-98 Endothelial Keratoplasty....Pages 99-114 Boston Keratoprosthesis....Pages 115-122 Laser-Assisted Keratoplasty and Post-keratoplasty Management....Pages 123-132 Eye Banking: What the Eye Bank Can Do for You Now....Pages 133-143