Journal of Clinical Medicine

Research

9 pages, 761 KB

Open AccessArticle

Comparison of Conjunctival Flora Before and 12 Months After Dacryoendoscopic Recanalization for Lacrimal Passage Obstruction

by Takahiro Hiraoka, Sujin Hoshi, Kuniharu Tasaki and Tetsuro Oshika

J. Clin. Med. 2025, 14(21), 7778; https://doi.org/10.3390/jcm14217778 - 2 Nov 2025

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Abstract

Background/Objectives: To investigate the long-term changes in conjunctival bacterial flora before and after dacryoendoscopic recanalization for lacrimal passage obstruction using silicone tube intubation. Methods: This prospective study included 135 eyes with lacrimal passage obstruction that underwent lacrimal passage recanalization and were [...] Read more.

Background/Objectives: To investigate the long-term changes in conjunctival bacterial flora before and after dacryoendoscopic recanalization for lacrimal passage obstruction using silicone tube intubation. Methods: This prospective study included 135 eyes with lacrimal passage obstruction that underwent lacrimal passage recanalization and were followed for at least one year. The silicone tubes inserted during surgery were removed three months postoperatively in all cases. The study period was from November 2018 to January 2025. Conjunctival samples were obtained before surgery and at 12 months postoperatively. Aerobic cultures were performed to detect bacterial flora. The culture positivity rate, number of bacterial species identified, and proportion of commensal bacteria were compared before and after surgery. Results: The bacterial culture positivity rate significantly decreased from 36.3% preoperatively to 20.0% postoperatively (p = 0.003). The number of bacterial species detected decreased from 15 to 6, with Gram-negative bacilli decreasing from 6 species to 1. In contrast, the proportion of commensal bacteria such as coagulase-negative staphylococci and Corynebacterium spp. relatively increased from 49.1% to 80.7%. No drug-resistant bacteria were detected postoperatively. Conclusions: Dacryoendoscopic recanalization for lacrimal passage obstruction was shown to achieve long-term normalization of the conjunctival bacterial flora by reducing pathogenic and drug-resistant bacteria and increasing commensal bacteria. These findings suggest that the procedure prior to intraocular surgery in patients with lacrimal obstruction may reduce the risk of postoperative infection. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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11 pages, 398 KB

Open AccessArticle

Accelerated CXL Versus Accelerated Contact-Lens Assisted CXL Treatment for Progressive Keratoconus—A 3-Year Retrospective Comparative Follow-Up

by Anna Bunin, Shmuel Kagasov, Nir Amitai, Tomer Kerman, Ran Matlov Kormas, Soosan Jacob, Raimo Tuuminen, Liron Kravitz and Boris Knyazer

J. Clin. Med. 2025, 14(20), 7141; https://doi.org/10.3390/jcm14207141 - 10 Oct 2025

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Abstract

Background: Contact lens-assisted corneal cross-linking can be used to treat keratoconus in patients with thin corneas under measuring less than 400 µm. This study compares the long-term clinical and tomographic outcomes between accelerated corneal cross-linking (A-CXL) and accelerated contact lens-assisted corneal cross-linking (A-CACXL). [...] Read more.

Background: Contact lens-assisted corneal cross-linking can be used to treat keratoconus in patients with thin corneas under measuring less than 400 µm. This study compares the long-term clinical and tomographic outcomes between accelerated corneal cross-linking (A-CXL) and accelerated contact lens-assisted corneal cross-linking (A-CACXL). Methods: Patients who underwent either A-CXL or A-CACXL protocol due to progressive keratoconus were enrolled in this retrospective cohort study conducted between January 2015 and December 2018. The control group (patients with minimum corneal thickness of at least 400 µm, comprising 32 eyes of from 32 patients) was treated with A-CXL, whereas the treatment group (patients that had minimum corneal thickness after epithelial removal below 400 µm; 30 eyes of from 30 patients) underwent the A-CACXL protocol. Clinical and tomographic data were obtained from a 3-year follow-up period. Results: At 3 years, both groups represented a significant gain in best-corrected visual acuity (from 0.32 to 0.18 LogMAR units for A-CXL, p = 0.001; from 0.51 to 0.33 LogMAR units for A-CACXL, p = 0.037). Furthermore, postoperative tomographic parameters (Kmax, Kmean, or corneal astigmatism) were comparable between the two protocols. Progression of keratoconus was halted among 87% of eyes in the A-CXL group and among 73% of eyes in the A-CACXL group (p = 0.2). Conclusions: A-CACXL treatment is an effective and safe option for patients with keratoconus and thin corneas, yielding long term outcomes comparable to those of A-CXL treatment for patients with a minimum corneal thickness of 400 µm following a 3-year follow-up. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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8 pages, 6401 KB

Open AccessArticle

Performance of a Trocar Sleeve Adapter for Faster Silicone Oil Extraction in Real-World Vitreoretinal Surgery

by Philip Wakili, Colya N. Englisch, Peter Szurman, Clara E. Englisch, Clemens N. Rudolph, Núria Pérez Guerra, Anna Theresa Fröhlich, Boris V. Stanzel and Karl T. Boden

J. Clin. Med. 2025, 14(17), 6052; https://doi.org/10.3390/jcm14176052 - 27 Aug 2025

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Abstract

Objectives: To assess the performance of a high-flow viscous-fluid-extraction cannula as a 23G trocar sleeve adapter (1362.VFE2, DORC, Zuidland, the Netherlands) for removing regular and heavy silicone oil (SO) in real-world vitreoretinal surgery. Methods: In this retrospective study, 90 eyes undergoing [...] Read more.

Objectives: To assess the performance of a high-flow viscous-fluid-extraction cannula as a 23G trocar sleeve adapter (1362.VFE2, DORC, Zuidland, the Netherlands) for removing regular and heavy silicone oil (SO) in real-world vitreoretinal surgery. Methods: In this retrospective study, 90 eyes undergoing SO removal were analyzed. The 23G trocar sleeve adapter was evaluated in 30 eyes for regular SO (DORC Silicone 5000) and 30 eyes for heavy SO (Densiron^® 68). The latter were compared with a standard disposable heavy-SO-extraction cannula (1272.HSE06, DORC) in another 30 eyes. Results: Removal of DORC Silicone 5000 using the trocar sleeve adapter required 332.0 ± 122.8 s. To extract Densiron^® 68, the adapter was significantly faster than the standard heavy-SO cannula (162.6 ± 85.6 s vs. 619.3 ± 128.8 s; p < 0.0001). Conclusions: The 23G trocar sleeve adapter efficiently extracts both regular and heavy SO, reducing the time required to extract Densiron^® 68 by four-fold compared with a dedicated heavy-SO cannula. Its use can markedly shorten surgical time in real-world vitreoretinal procedures. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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12 pages, 1600 KB

Open AccessArticle

Visual Outcomes and Patient Satisfaction with Extended Monovision—An Innovative Strategy to Achieve Spectacle Independence in Refractive Lens Exchange

by Dana Nagyova, Christoph Tappeiner, Andrej Blaha, David Goldblum and Dimitrios Kyroudis

J. Clin. Med. 2025, 14(16), 5684; https://doi.org/10.3390/jcm14165684 - 11 Aug 2025

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Abstract

Background: Spectacle independence is a key goal in refractive lens exchange (RLE), especially in younger, high-expectation patients. This study evaluates a novel extended monovision approach combining a monofocal aspheric intraocular lens (IOL) in the dominant eye with a rotationally asymmetric bifocal extended-depth-of-focus [...] Read more.

Background: Spectacle independence is a key goal in refractive lens exchange (RLE), especially in younger, high-expectation patients. This study evaluates a novel extended monovision approach combining a monofocal aspheric intraocular lens (IOL) in the dominant eye with a rotationally asymmetric bifocal extended-depth-of-focus (EDOF) IOL in the non-dominant eye. The strategy aims to optimize full-range visual performance while minimizing photic phenomena. Methods: In this retrospective cohort study, presbyopic patients underwent bilateral RLE with a monofocal IOL (Hoya Vivinex XC1-SP; target: 0 diopters [D]) in the dominant eye and a rotationally asymmetric bifocal EDOF IOL (LENTIS LS-313 MF15; addition: +1.5 D; target: −1.25 D) in the non-dominant eye. Uncorrected distance visual acuity (UDVA, at 6 m), uncorrected intermediate visual acuity (UIVA, at 66 cm), and uncorrected near visual acuity (UNVA, at 36 cm) were assessed. Additional evaluations included binocular defocus curves, contrast sensitivity, stereoacuity, and photic phenomena. Spectacle independence and satisfaction were measured using the PRSIQ and NEI-RQL-42 questionnaires. Results: A total of 38 patients (76 eyes) were included. The mean postoperative binocular UDVA, UIVA, and UNVA were −0.03 ± 0.08, −0.08 ± 0.09, and 0.04 ± 0.08 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m) with a mean visual acuity of −0.03 ± 0.08 logMAR. Functional vision better than 0.2 logMAR extended over defocus steps from +1.00 to −3.25 D. All patients were spectacle-independent for distance and intermediate vision, and 84% reported complete spectacle independence. Contrast sensitivity was within normal limits for age. Minimal photic phenomena were reported, and stereoacuity was preserved in 97% of patients (≤100 arcseconds). Conclusions: This innovative extended monovision approach, combining two different IOLs in a mini-monovision setup, provides excellent uncorrected visual acuity at all distances, high spectacle independence, and minimal side effects. It represents a compelling alternative to multifocal IOL implantation in presbyopic RLE candidates. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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8 pages, 197 KB

Open AccessArticle

Descemet Stripping Only for Symptomatic Fuchs Endothelial Dystrophy—A Retrospective Case Series Comparing ROCK-I vs. Hypertonic Sodium Chloride for Post-Surgical Adjuvant Therapy

by Eyal Cohen, Nizar Din, Sultan Aldrees, Michael Mimouni, Tanya Trinh, Nir Sorkin, Larissa Gouvea, Clara C. Chan and Allan R. Slomovic

J. Clin. Med. 2025, 14(5), 1512; https://doi.org/10.3390/jcm14051512 - 24 Feb 2025

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Abstract

Purpose: To report our experience with Descemet stripping only (DSO) for the treatment of Fuchs endothelial corneal dystrophy. Methods: Thirteen eyes of 9 patients with symptomatic Fuchs endothelial dystrophy underwent a 4 mm central Descemetorhexis without graft implantation between June 2017 and [...] Read more.

Purpose: To report our experience with Descemet stripping only (DSO) for the treatment of Fuchs endothelial corneal dystrophy. Methods: Thirteen eyes of 9 patients with symptomatic Fuchs endothelial dystrophy underwent a 4 mm central Descemetorhexis without graft implantation between June 2017 and July 2020. All patients had central confluent guttata, undetectable central endothelial cell count by specular microscopy, and healthy peripheral corneal endothelium. In 6 eyes, the procedure was combined with phacoemulsification and intraocular lens implantation. Eight eyes were treated with topical rho-associated protein kinase (Rock) inhibitors and five eyes were treated with hypertonic sodium chloride 5%, post operatively. Results: All eyes completed at least 4 months of post-operative follow-up (mean follow-up 12.0 ± 7.9 mo; 4–29 mo). Mean patient age was 70 ± 6 years. All eyes achieved corneal clearance with an average time for clearance of 7.2 ± 2.4 weeks. Mean endothelial cell count postoperatively was 778 ± 228. Mean central corneal thicknesses pre- and postoperatively were 620 ± 100 and 560 ± 58 μm, respectively. Eleven eyes achieved improvement in visual acuity and in two eyes vision remained unchanged, with mean visual acuity 0.392 to 0.225 logMAR; p = 0.001. Also, all patients reported subjective improvement in the quality of vision. ROCK inhibitors compared to hypertonic sodium chloride 5% did not show statistically significant differences in time for corneal clearance or endothelial cell counts postoperatively but did show a trend towards faster corneal clearance and higher endothelial cell counts postoperatively among the ROCK inhibitors-treated eyes. Conclusions: In patients with Fuchs endothelial dystrophy and visual degradation secondary to central guttata, DSO represents a viable procedure for visual rehabilitation. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

8 pages, 191 KB

Open AccessArticle

Combined Penetrating Keratoplasty and Vitrectomy: Long-Term Follow-Up Results

by Orit Vidne-Hay, Amir Alhalel and Irina S. Barequet

J. Clin. Med. 2024, 13(23), 7468; https://doi.org/10.3390/jcm13237468 - 8 Dec 2024

Cited by 2 | Viewed by 1173

Abstract

Purpose: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). Methods: A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations [...] Read more.

Purpose: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). Methods: A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations were retrieved. Results: Thirteen consecutive eyes (13 patients) were enrolled. The mean age was 51.5 ± 20.5 years, and the mean follow-up time was 67 ± 36.9 months. All cases had severe corneal opacity. Indications for surgery included retinal detachment (76.9%), dropped lens (7.7%), dropped intraocular lens (7.7%), and endophthalmitis with corneal abscess (7.7%). Visual acuity improved in 46.1% of the cases, though in most cases visual acuity remained low, and decreased in 23% of the cases. In 23% of the cases (3 eyes), ambulatory vision was achieved for more than 12 months and in 15.4% for three years. Silicone oil tamponade was used in all cases of retinal detachment (10 eyes). Of these eyes, at the final follow-up, four eyes were attached, two eyes were partially attached, and corneal opacity prevented retinal visualization in three eyes. One eye was eviscerated and one eye developed phthisis. Postoperatively, 61.5% of the cases underwent repeated PKP for graft decompensation. At the final visit, graft failure was observed in 75% of the cases. Conclusions: The long-term follow-up of eyes that underwent combined PKP and PPV supports this technique in complex cases for eye and vision preservation. The main problem after combined surgery is the long-term survival of the corneal graft which may require repeated PKP surgeries. With this approach, in 23% of the cases, ambulatory vision was maintained for more than 12 months. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

Review

Jump to: Research, Other

11 pages, 826 KB

Open AccessReview

Mushroom Penetrating Keratoplasty: A Narrative Review

by Pietro Bergamaschi, Linda Marie Louise Busin, Angeli Christy Yu and Massimo Busin

J. Clin. Med. 2025, 14(7), 2351; https://doi.org/10.3390/jcm14072351 - 29 Mar 2025

Cited by 1 | Viewed by 831

Abstract

While full-thickness penetrating keratoplasty (PK) has seen a decline in favor of partial-thickness techniques like endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK), PK remains indicated for corneal disease involving the entire corneal thickness. Mushroom keratoplasty (MK) is a noteworthy modification of PK, [...] Read more.

While full-thickness penetrating keratoplasty (PK) has seen a decline in favor of partial-thickness techniques like endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK), PK remains indicated for corneal disease involving the entire corneal thickness. Mushroom keratoplasty (MK) is a noteworthy modification of PK, designed to combine the refractive benefits of a large-diameter anterior lamellar graft with the graft survival advantage of limited replacement of the corneal endothelium. Leveraging the use of a microkeratome, the MK donor graft can be prepared by microkeratome dissection, thereby achieving a central interface compatible with 20/20 Snellen vision. This review explores the various surgical techniques, visual outcomes, graft survival rates, and complication rates associated with MK for various indications. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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Other

Jump to: Research, Review

10 pages, 1886 KB

Open AccessCase Report

Novel Surgical Approach for Aphakia and Iridodialysis: Artificial Iris and Scleral-Fixated Lens as a Single Complex

by Guglielmo Parisi, Agostino Salvatore Vaiano, Claudio Foti, Francesco Gelormini, Federico Ricardi, Fabio Conte, Maria Marenco, Paola Marolo, Enrico Borrelli and Michele Reibaldi

J. Clin. Med. 2025, 14(5), 1599; https://doi.org/10.3390/jcm14051599 - 27 Feb 2025

Viewed by 1736

Abstract

Background: Artificial iris (AI) implantation is an innovative and increasingly utilized surgical procedure for injured eyes with iris trauma. Methods: A 76-year-old female and a 34-year-old male presented at the emergency department with a traumatic corneo-scleral laceration and perforated corneal ulcer, respectively. [...] Read more.

Background: Artificial iris (AI) implantation is an innovative and increasingly utilized surgical procedure for injured eyes with iris trauma. Methods: A 76-year-old female and a 34-year-old male presented at the emergency department with a traumatic corneo-scleral laceration and perforated corneal ulcer, respectively. Emergency surgeries were performed to restore ocular integrity. In both cases, a modified surgical technique involving the implantation of an AI was performed; however, two different models of AI were used. Results: The AIs were sutured with four stitches directly to the scleral-fixated (SF) intra ocular lens (IOL), and the AI-IOL complexes were implanted, as a single unit, and fixated to the sclera using the lens haptics. Before and after the surgery, patients underwent a comprehensive eye examination, including a visual acuity test. The AI-SF IOL complexes remained well positioned, with no intraocular or extraocular complications observed during the follow-up evaluations of both patients. Conclusions: We reported a straightforward and repeatable modified surgical technique for two patients with two models of AI, both sutured to the SF IOL and fixated to the sclera, as a single unit. This approach may serve as an excellent alternative for managing aphakic eyes with extensive iridodialysis or partial aniridia. Full article

(This article belongs to the Special Issue New Insights in Ophthalmic Surgery)

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