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Epi-Bowman Blunt Keratectomy Versus Diluted EtOH Epithelial Removal in Myopic Photorefractive Keratectomy: A Prospective Contralateral Eye Study

Vingopoulos, Filippos; Kanellopoulos, Anastasios John
PURPOSE/OBJECTIVE:To compare the outcomes and complications of Epi-Bowman blunt keratectomy (EBK) using a blunt epikeratome (Epi-Clear, Orca Surgical, Israel), with alcohol delamination of the corneal epithelium during photorefractive keratectomy (PRK) in contralateral eyes. METHODS:This prospective, randomized contralateral eye study included 44 eyes of 22 patients undergoing PRK for bilateral myopia or myopic astigmatism. In each patient, epithelial delimitation was performed using an Epi-Clear epikeratome EBK (EBK group) on 1 eye and diluted ethanol (EtOH) on the fellow eye (EtOH group). Postoperative pain, epithelial healing, epithelial profile, and visual outcome were compared between the 2 groups. RESULTS:The mean postoperative pain scores were 0.37 ± 0.25 for the EBK group and 0.82 ± 0.22 for the EtOH group (P = 0.043). The mean epithelial defect size at day 3 postoperatively was 1.61 ± 1.46 and 2.25 ± 1.69 mm, respectively (P = 0.034). The postoperative 3-month remaining mean spherical equivalent was 0.04 ± 0.49 diopters for the EBK group and 0.21 ± 0.26 D for the EtOH group (P = 0.520). There was no significant difference in UCVA and BCVA between the groups. CONCLUSIONS:Our data suggest that this novel EBK device and technique may minimize postoperative pain, accelerate re-epithelialization, and offer earlier visual recovery, compared with EtOH when used for myopic PRK.
PMID: 30640250
ISSN: 1536-4798
CID: 3595172

Comparison of Corneal Epithelial Remodeling Over 2 Years in LASIK Versus SMILE: A Contralateral Eye Study

Kanellopoulos, Anastasios J
PURPOSE/OBJECTIVE:To evaluate 3-dimensional epithelial remodeling in patients undergoing myopic laser in situ keratomileusis (LASIK) versus small incision lenticule extraction (SMILE). METHODS:In a prospective randomized contralateral eye study of LASIK versus SMILE procedures, 21 consecutive patients (42 eyes) were evaluated with corneal epithelial mapping by anterior segment optical coherence tomography for up to 2 years. RESULTS:In the LASIK group, central epithelial thickness increased from 52.38 ± 2.57 μm to 57.00 ± 4.23 μm and remained almost stable at this level for up to 24 months. In the SMILE eyes, it increased from 52.52 ± 3.01 μm to 57.15 ± 4.57 μm and also remained stable for up to 24 months. Both techniques created the same level of epithelial thickness increase and variation, with a significantly higher mid-peripheral epithelial thickness increase. The differences between the preoperative and postoperative changes were found statistically significant, but not different between the 2 techniques at any given time studied. CONCLUSIONS:Both LASIK and SMILE resulted in significant epithelial thickening. This response seemed to be surprisingly quite similar between the 2 different techniques. This study suggests that epithelial remodeling may correlate with relative curvature changes resulting after both techniques, rather than the obvious difference of subepithelial corneal denervation changes.
PMID: 30721171
ISSN: 1536-4798
CID: 3632102

The impact of keratoconus treatment with the Athens Protocol (partial topography-guided photorefractive keratectomy combined with higher-fluence corneal collagen cross-linking) on quality of life: a long-term study

Kanellopoulos, Anastasios John
Purpose/UNASSIGNED:The aim of this study was to evaluate the health-related quality of life (HRQoL) before and after the management of keratoconus (KCN) with Combined Topography-Guided Transepithelial partial photorefractive keratectomy (PRK) and corneal Cross-Linking: the Athens Protocol. Patients and methods/UNASSIGNED:Thirty-four consecutive patients treated for progressive KCN were selected for retrospective telephone interview and individual questionnaire submission. A disease-specific HRQoL questionnaire was administered before and after the Athens Protocol intervention, using the following administrative questionnaires: National Eye Institute Visual Function Questionnaire (NEI VFQ) 25/39 and IVI-28. The disease grade was ranked according to the Amsler-Krumeich classification (KCN severity). Reliability of collected data was evaluated with Cronbach's α test. Results/UNASSIGNED:Patients' age ranged from 15 to 51 years at the time of the operation. Mean time before the operation during which the questionnaires were administered was 52±6 months. General visual acuity, psychological well-being, and driving ability showed significant improvement. Younger keratoconic patients tend to have more enhanced psychological status and to cope better with difficulties in everyday activities (prior to operation) than older patients. Conclusion/UNASSIGNED:The Athens Protocol treatment has been proven to be beneficial to patients in a large number of aspects.
PMCID:6501993
PMID: 31118557
ISSN: 1177-5467
CID: 4271482

Management of progressive keratoconus with partial topography-guided PRK combined with refractive, customized CXL - a novel technique: the enhanced Athens protocol

Kanellopoulos, Anastasios John
Purpose/UNASSIGNED:To report a novel application of partial topography-guided photorefractive keratectomy combined with topographically customized, higher fluence, and variable pattern corneal cross-linking applied on the same day of the treatment of keratoconus. Methods/UNASSIGNED:fluence for a total of 5-10 J, and up to 15 J of energy was delivered with the KXL-II device employing an active tracker. The center of the pattern that received the 15 J was topography-matched with the thinnest area of the cone. Visual acuity, refractive error, cornea clarity, keratometry, topography, pachymetry with a multitude of modalities and endothelial cell density were evaluated over 36 months. Results/UNASSIGNED:Keratoconus was stabilized in all cases. The severity of keratoconus stage by Amsler- Krumeich criteria improved from an average of 3.2 (1-4) to 1.8 (0-3). Uncorrected distance visual acuity changed from preoperative 20/80 to 20/25 at 6 months. A maximum astigmatic reduction of 7.8 D (5.3-15.6), and a significant cornea surface normalization (an index of height decentration improvement from 0.155 [±0.065] to 0.045 [±0.042]) were achieved by 1 month and remained relatively stable for 36 months postoperatively. Two cases delayed full reepithelialization for up to 9 days. Conclusion/UNASSIGNED:This paper introduces a novel technique in order to maximize the refractive normalization effect along with ectasia stabilization in young keratoconus patients. This may facilitate the use of less tissue ablation, in comparison to utilizing a homogeneous UV light beam for corneal cross-linking in Athens Protocol cases. It broadens the number of potential candidate cases that would have been limited to employ this technique due to tissue thickness limitations.
PMCID:6453552
PMID: 31040638
ISSN: 1177-5467
CID: 3854692

Incidence and management of symptomatic dry eye related to LASIK for myopia, with topical cyclosporine A

Kanellopoulos, Anastasios John
Purpose/UNASSIGNED:To evaluate the incidence of transient dry eye associated with LASIK for myopia and the efficacy of topical cyclosporine A administration. Methods/UNASSIGNED:Group A was formed from 145 (82 female, 63 male) eyes that developed clinically significant dry eye within 1 month post-LASIK and were subjected to cyclosporine A treatment. A "non-symptomatic for dry eye" and age- and gender-matched group (group B) was formed from the same pool of patients to serve as control. Schirmer's, tear film break-up time (TBUT) and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. Central corneal epithelial thickness (CET) and topographic epithelial thickness variability (TVT) were evaluated as quantitative dry eye objective markers. Subjective patient survey was also assessed. Results/UNASSIGNED:<0.05), respectively. Following commencement of cyclosporine A treatment in group A, statistically significant improvement was noted, greater than the one in group B, in all metrics at the 12-month examination in comparison to the 1-month baseline. Conclusion/UNASSIGNED:Topical cyclosporine A treatment is an effective alternative in the management of LASIK for myopia-related transient dry eye. Optical coherence tomography epithelial mapping may provide an objective benchmark in diagnosing and monitoring this significant disorder and its correlation with visual symptoms.
PMCID:6438263
PMID: 30988596
ISSN: 1177-5467
CID: 3810432

Combining Porcine Xenograft Intra-Corneal Ring Segments and CXL: a Novel Technique

Kanellopoulos, Anastasios John; Vingopoulos, Filippos
Purpose/UNASSIGNED:The ex-vivo feasibility of creating corneal ring segments (ICRS) from biological tissue (xenograft porcine cornea) and combining intra-corneal implantation with Corneal CrossLinking (CXL). Methods/UNASSIGNED:The ring segments from gamma-irradiated porcine donor cornea were shaped and implanted in human cadaver host cornea using a femtosecond laser for their dissection and host cornea channel preparation. Intra-channel 0.25% riboflavin solution combined with higher fluence CXL of 15 joules total energy followed their implantation. Anterior segment Optical Coherence Tomography (OCT), Scheimpflug tomography and Placido-disc topography were used to monitor the positioning and refractive effect. Results/UNASSIGNED:The novel xenograft ring segments were positioned as planned at 85% corneal depth and mid-peripheral, with documented, up to 7 diopters central cornea flattening. Conclusion/UNASSIGNED:Xenograft intracorneal ring segments combined with CXL may offer an alternative to the synthetic materials used clinically so far, aiming in reducing complications of intracorneal opaque deposit accumulation, segment migration, corneal erosion and potential extrusion. Combining CXL may enhance their refractive effect and stabilize potential or documented host ectasia.
PMCID:6925549
PMID: 31908406
ISSN: 1177-5467
CID: 4257152

The Latest in IOLs: Light Adjustable and Trifocal IOLs-Experience from Aboard

Kanellopoulos, A J
Purpose of Review: To investigate the latest findings in the field of intraocular lenses and their future development. Recent Findings: The idea of intraocular lenses (IOLs) has changed the clinical practice of cataract surgery over the last 50 years. Technology and scientific studies have created IOLs of different designs, with ultraviolet filters for UV protection, different types of haptics to ensure stability, multifocal designs for distant, and near vision. IOLs' development is fast and it is time to explore the new designs and their usefulness. Summary: The newest data from the IOL field are on light adjustable and trifocal IOLs, which are presented herein and are expected to change our perspective and lead the way in even more complicated and useful IOLs.
EMBASE:625337642
ISSN: 2167-4868
CID: 3553362

Topography-Guided LASIK versus Small Incision Lenticule Extraction: Long-term Refractive and Quality of Vision Outcomes

Kanellopoulos, Anastasios John
PMID: 29754993
ISSN: 1549-4713
CID: 3121262

September consultation #3

Kanellopoulos, A John
PMID: 30165939
ISSN: 1873-4502
CID: 3256172

Comparison of corneal biomechanics after myopic small-incision lenticule extraction compared to LASIK: an ex vivo study

Kanellopoulos, Anastasios John
Purpose/UNASSIGNED:To investigate ex vivo potentially different corneal biomechanical properties after small-incision lenticule extraction (SMILE) versus LASIK for myopic correction. Methods/UNASSIGNED:Thirty human donor corneas were subjected to either myopic SMILE or femtosecond laser-assisted LASIK. Donor corneas were assigned to six investigative groups: Group A, -3.00 D (diopters) SMILE; Group B, -8.00 D SMILE; Group C, -3.00 D LASIK; and Group D, -8.00 D LASIK. Additionally, two control groups were formed: Group E, SMILE and Group F, LASIK. All groups consisted of five corneas, randomly allocated. The corneas in the control groups were subjected to the corresponding femtosecond-laser lamellar cuts but not to tissue removal. Evaluation of biomechanical tensile strength was conducted by biaxial force application. Primary outcome measures were stress at 10% and 15% strain, and Young's modulus at 10% and 15% strain. Results/UNASSIGNED:In SMILE, the average relative difference (Δ) of the four outcome measures was -34.46% for -3.00 D correction versus control Group E and -49.34% for -8.00 D correction versus control Group E. In LASIK, average Δ was -24.88% for -3.00 D correction versus control, and -52.73% for -8.00 D correction versus control. All these differences were statistically significant; SMILE compared to LASIK for the same myopic correction appears to result in more biomechanical reduction for -3.00 D corrections by -26%, while a nonstatistically significant difference was noted in -8.00 D corrections. Conclusion/UNASSIGNED:Both SMILE and LASIK procedures do substantially alter corneal biomechanical properties, and the degree of tensile strength reduction is statistically significantly correlated to the extent of myopic correction. Additionally, SMILE procedure seems to result in more tensile strength reduction in lower myopic corrections compared to LASIK, and similar tensile strength reduction to LASIK in higher myopic corrections when compared to LASIK.
PMCID:5790083
PMID: 29416315
ISSN: 1177-5467
CID: 2947772