Upload File

clinical outcome of dalk in keratoconus – a one year follow up authors: somasheila i murthy, md,...

  • Home
  • Documents
  • Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and
12
Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and Prashant Garg, MD. Affiliation: Cornea and anterior segment service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India The authors have no financial interest in the subject matter of this

Upload: madison-eaton

Post on 17-Jan-2016

218 views

Category:

Documents


2 download

Report

Tags:

TRANSCRIPT

Page 1: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

Clinical outcome of DALK in Keratoconus – A one year follow up

Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD

and Prashant Garg, MD.

Affiliation: Cornea and anterior segment service, L. V. Prasad Eye Institute, Kallam Anji Reddy

Campus, Hyderabad, India

The authors have no financial interest in the subject matter of

this poster

Page 2: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•Study purpose: To evaluate the visual outcome and complications of deep anterior lamellar keratoplasty (DALK) in keratoconus

•Study design: retrospective interventional case series

•Study location: Cornea and anterior segment service, LV Prasad eye Institute, Hyderabad, India

Methods

•Inclusion criteria: all cases of keratoconus that underwent DALK with a minimum follow-up of one year

•Pre-operative evaluation included:

•Visual acuity•Slit lamp examination•Central corneal thickness•Corneal topography

Page 3: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

The data obtained included: pre and post-operative:

•Best corrected Snellen’s visual acuity•Slit-lamp examination for assessment of graft clarity•Central corneal thickness •Corneal topography using Orbscan•Anterior segment optical coherence tomography post-operatively in some cases

Methods

•Surgical technique: •2 techniques:

•Big-bubble technique •Manual dissection in layers•Combination

•Primary outcome measures:•Visual acuity•Graft clarity

•Secondary outcome measures:•Nonprogression of keratoconus•Graft failure due to edema or rejection•Complications rate

Page 4: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•During 2004 to 2008, 49 eyes of 48 patients underwent DALK•Twenty-two eyes completed one year follow-up•Mean age: 18.63 (range 11 to 43 years) with 77% under 20 years•Fifteen were male and seven female patients

Results

Age Eyes (%)

11 – 20 yrs 17 ( 77%)

21 – 30 yrs 2 (9%)

31 – 40 yrs 2 (9 %)

> 40 yrs 1(4.5%)

Table 1: Age distribution

Page 5: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

Visual acuity

> 20/ 60

Eyes

6

20/60 – 20/ 200 4

20/200 – 20/400 3

<20/400 13 (60%)

Table 2: Pre-operative visual acuity

Visual acuity

20/20-20/40

Eyes

16 (73%)

20/40-20/60 2

20/60-20/80 2

< 20/80 2

Table 3: Post-operative visual acuity

Results: pre and post-operative visual acuity

Page 6: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

Results

Big bubble 7

Manual lamellar dissection

3

Combination 12

Total 22

Table 4: Surgical technique

•Corneal thickness ranged from 427 to 591 microns

•Donor graft size ranged from 7.5 to 10.5

Page 7: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

Results: graft clarity and complications

Clear graft 16 (73%)

Interface haze 2

Scarring 3

Pigments on endothelium

1

Table 5: Graft clarity

Suture related

9

Vascularisation

3

PAS 1

None 8

Table 6: Complications

Page 8: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•Best-corrected visual acuity at one year was 20/40 or better in 16/22 cases (73%)

•16/22 cases had clear graft, with 5/22 showing interface haze or scarring

•No major complications like glaucoma, graft failure or progression were noted

•Minor suture related complications (loose or broken sutures) were noted in 9 eyes (40%)

Summary

Page 9: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•Penetrating keratoplasty is the accepted surgical treatment for keratoconus and has an excellent five-year graft survival rate1,2

•However, it can fail due to allograft rejection and endothelial cell loss

•Deep anterior lamellar keratoplasty replaces anterior diseased part of the cornea while retaining the host endothelium and has the advantage of reducing the risks of graft rejection and intraocular complications

Discussion

Page 10: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•Various authors have reported their results of DALK and have shown comparable visual acuities with PK with fewer post-operative complications3, 4,

5 Our study also shows similar results

• Therefore, despite this technique being more demanding surgically, it is worthwhile to perform DALK for keratoconus and PK should be done only as a last resort

Discussion

Page 11: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

•Visual acuity outcomes of DALK in keratoconus are good in majority of cases

•In comparison to penetrating keratoplasty, there are fewer post-operative complications and majority encountered were minor

•DALK is perhaps the preferred choice for the surgical management of keratoconus

Conclusions

Page 12: Clinical outcome of DALK in Keratoconus – A one year follow up Authors: Somasheila I Murthy, MD, Smruthi rekha Priyadarshini, MD, Jagadesh Reddy, MD and

1. Pramnik S, Musch DC, Sutphin JE, Farjo AA. Extended long-term outcomes

of penetrating keratoplasty for keratoconus. Ophthalmology 2006;113:1633-

1638

2. Zadok D, Schwarts S, Marcovich A, et al. Penetrating keratoplasty for

keratoconus: long term results. Cornea 2005;24:959-961

3. Watson SL, Ramsay A, Dart JKG, et al. Comparison of deep lamellar

keratoplasty with penetrating keratoplasty in patients with keratoconus.

Ophthalmology, 2004;111:1676-1682

4. Sarnicola V, Toro P, Gentile D, et al. Descemetic DALK and pre-descemetic

DALK: outcomes in 236 cases of keratoconus. Cornea 2010 Jan;29(1):53-9

5. Han DY, Mehta JS, Por YM et al. Comparison of outcomes of lamellar

keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol

2009;148(5):629-31

References:


PERMA PURE · md-050+wl±fie md-050-12 md-050-24 md-050-48 md-050-72 -20 õ -30 -40 10 -20 -25 md-070-12 md-070-48 md-070-24 md-070-72 md-070-96 md-070-144

 · Sadhana Chheda, MD Robert Christenson, MD Alison Days, MD Rodolfo Fierro-Stevens, MD Angela Flores, MD ... Osama Naga, MD Jagdish Patel, MD Jignesh Patel, MD

M. Vokrojova MD, M. Vokrojova MD, D. Sivekova MD, L. Wagnerova MD D. Sivekova MD, L. Wagnerova MD Prof. P. Kuchynka MD, PhD Prof. P. Kuchynka MD, PhD The

20H-MD / 40H–MD / 60H-MD

Emory Department of Anesthesiology...Meka, MD Max Schubert, MD Tyler Smith, MD Zia Siddiqui, MD Annie Song, MD Eric Yao, MD Sai Alla, MD Alex Balmaceda, MD Jay Bryant, MD Cristen Cain,

 · timothy j. marten, md mohsen naraghi. md pietro palma, md norman j. pastorek md stephen w. perkins, md volney pitombo, md brunno ristow md enrico robotti, md rod j. rohrich, md

Alison McInturff, MD 232-1443...David Denton, MD Matthew Murdoch, MD Brian Fulks, MD Gentry Yost, MD Shaun Summerill, MD Laura Duty, MD Elizabeth Parsons, MD Matthew Stelzer, MD David

Authors Lin Chang, MD Jennifer Christie, MD Rosemarie Fisher, MD Rebekah Gross, MD Amy Foxx-Orenstein, MD Asma Khapra, MD Caroline Loeser, MD Suwebatu

Smart Data Monitoring System for Power Loom Using IOT · Smart Data Monitoring System for Power Loom Using IOT 1M. Saravanan , 2M. Jagadesh , 3V. Deepan , 4R. Divya , 5S. Gowri Manohari

Click Here to Register - L. V. Prasad Eye Institute · Panelists: Himanshu Matalia, Mohamed Alaa El-Danasoury, Abhinav Biala - Moderator: Somasheila Murthy 19:30-19:45: Up, Up and

Comparison of Endothelial Cell Count by Manual and Automated Methods in Normal Corneas and in Fuchs' Endothelial Dystrophy Somasheila I Murthy, Debarun

Jagadesh Excel

· PDF fileIndia Bio Nano Electronics ... Prof. S. Basu Chemical Engineering& Prof. Toru Maekawa, BNERC, Toyo University. ... Prof. Jagadesh Kumar, Electrical

American Thoracic Society · Farrukh Abbas, MD Ahmed Abdelbasit, MD Dionne Adair, MD Muhammad Ali, MD Nancy Allen, MD Dagny Anderson, MD Juan Barron, MD Sarah Bauer, MD Moeezullah

2wl.wum.edu.pl · MD PhD, Marek Janiak MD, Marek Paśnicki MD, Paweł Zatorski MD PhD, Jan Pluta MD, Ewa Puchalska-Kowalczyk MD, Piotr Andrzejak MD, Anna Gruźlewska MD, Mateusz Klukowski

Sílvia Monteiro MD, Inês Casal MD, Ana Figueiredo MD ... · Sílvia Monteiro MD, Inês Casal MD, Ana Figueiredo MD, Carolina Vale MD, Maria João Furtado MD, Angelina Meireles MD

METREL MD 9040 & MD 9050 … · METREL MD 9040 & MD 9050 . MD 9040. TRMS Industrial Digital Multimeter . MD 9050 TRMS. Heavy Duty Industrial Digital Multimeter . MD 9040 & MD 9050

M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP ... · M Krishnamoorthy MD, S Krishnamoorthy MD, J Beard MD, FACP, J Bolyard MD, FACP, A Chakka MD, FACP, J. Sutton MD,

Clinical Outcomes and Risk Factors for Graft Failure After Keratoplasty for Macular Corneal Dystrophy Jagadesh C. Reddy Somasheila I. Murthy, Prashant

Microsporidial Stromal Keratitis : Dilemma in Clinical Diagnosis Swapnali Sabhapandit, MS Prashant Garg, MD Somasheila Murthy, MS Geeta K Vemuganti, MD

Scleritis: Diagnosis and Management - cybersight.org · Scleritis: Diagnosis and Management Somasheila Murthy Head of Service, Cornea Consultant, Uveitis Service Tej Kohli Cornea

Yonca A . Akova , MD, Mehmet Borazan, MD; Aylin Karalezli, MD; Cem Kucukerdonmez, MD ; Ahmet Akman , MD; Sevsen Kulaksizoglu, MD

Two days of refractive surgery. Period....Panelists: William Culbertson, Damien Gatinel, Arthur Cummings, D Ramamurthy - Moderator: Jagadesh Reddy 18:00-18:15 For your eyes only -

PAC Members · Edwin Hissa MD David Hochschild MD W Hodge FACS, MD Scott Hodges DO Rudolf Hoellrich MD Steven Hoer MD Eric Hoffman MD Mark Hollmann MD G Holloway MD Timothy Holt MD

Document5 - WordPress.com · md razib hossain ismail hossain md. abu hasan hero md. . syed anwar md md. salim md habibur rahman md.shajahan miah md. selim mondal md. siddikur rahman

Attendance for CRT 2018 batch Section - 1 Date: /06/17 Sections.pdf · 5 alavala veera satya venkatesh 14341a0105 ce 6 alikana ... 52 k lavanya 14341a0241 eee 53 jagadesh kolli

MP T.INTAN MD SELAMA MD T.MALIM MD B.GAJAH MD … · mp t.intan md selama md t.malim md b.gajah md p.tengah mp taiping mp manjung md kampar suk perak mb ipoh md kerian md gerik md

Katsuya Yamazoe, MD, Takefumi Yamaguchi, MD, Kazuki Hotta, MD, Yoshiyuki Satake, MD, Kenji Konomi, MD, Seika Den, MD, Jun Shimazaki, MD Presented by: Abdulrahman

Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD

D.Bruni, MD; L.Bragonzoni, PhD; M.Gagliardi, MD; M.Bontempi, PhD; Akkawi I, MD; G.Raspugli,MD, Tedi M, MD; S.Patella, MD; Prof. M.Marcacci, MD. Rizzoli

MD-2014 MD-3204 MD-3208 MD-3200 MD-3206 MD-3210 ......MD-5200 MD-5206 MD-CRMI MD-5204 MØRDEN MD-5210 DOORS LTD. #119, 13045-84 AVENUE SURREY, 183 TEE 604.592.0472 • FAX: 604.592.0462

MD BOL IV A MD µ0 MD

Daido Corporation of America · 2020. 1. 28. · (JIS.A TRU-PITCH Part No. TRC35-MD TRC41-MD TRC40-MD TRC50-MD TRC60-MD TRC80-MD TRCIOO-MD TRC120-MD TRC140-MD TRCI TRC180-MD TRC200-MD

IN THE HIGH COURT OF KARNATAKA AT BANGALOREjudgmenthck.kar.nic.in/judgmentsdsp/bitstream/123456789/32938/1/… · (by sri: d.l. jagadesh, adv. for r1 to 7) rfa filed u/s 96 of the

PHYSICIAN CHAIRMENPatrick McCarville, MD Joseph McCaslin, MD Lindsay Northam, MD Charles Olson, MD John Park, MD Jim Reilly, MD William Shiffermiller, MD Charles Ternent, MD Mark Wilson,