Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus
To identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity. Retrospective Cohort Study. Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus pat...
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| Veröffentlicht in: | American journal of ophthalmology 2020-04, Vol.212, p.127-133 |
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| creator | Scorcia, Vincenzo Giannaccare, Giuseppe Lucisano, Andrea Soda, Mauro Scalzo, Giovanna Carnovale Myerscough, James Pellegrini, Marco Verdoliva, Francesco Piccoli, Gabriele Bovone, Cristina Busin, Massimo |
| description | To identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity.
Retrospective Cohort Study.
Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019. Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment optical coherence tomography (AS-OCT)–based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro-/macroperforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.
Pneumatic dissection succeeded in 113 of 155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%), and 2 mixed-type (1.8%). Microperforations were managed conservatively in type 1 bubbles; macroperforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P = .006 and P < .013). Type 1 bubbles formed in eyes with significantly lower age, K-mean, and AS-OCT stages and higher pachymetric values (always P < .029). Age had the highest diagnostic power for discrimination between bubble types, followed by AS-OCT stage, pachymetry, K-mean, and astigmatism (respectively, AUC = 0.861, 0.779, 0.748, 0.700, 0.670).
Older age and advanced stages of keratoconus were predictors of type 2 bubble formation during BB-DALK that was associated with an increased risk of complications. |
| doi_str_mv | 10.1016/j.ajo.2019.12.012 |
| format | Article |
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Retrospective Cohort Study.
Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019. Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment optical coherence tomography (AS-OCT)–based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro-/macroperforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.
Pneumatic dissection succeeded in 113 of 155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%), and 2 mixed-type (1.8%). Microperforations were managed conservatively in type 1 bubbles; macroperforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P = .006 and P < .013). Type 1 bubbles formed in eyes with significantly lower age, K-mean, and AS-OCT stages and higher pachymetric values (always P < .029). Age had the highest diagnostic power for discrimination between bubble types, followed by AS-OCT stage, pachymetry, K-mean, and astigmatism (respectively, AUC = 0.861, 0.779, 0.748, 0.700, 0.670).
Older age and advanced stages of keratoconus were predictors of type 2 bubble formation during BB-DALK that was associated with an increased risk of complications.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/j.ajo.2019.12.012</identifier><identifier>PMID: 31883463</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Contact lenses ; Cornea ; Corneal Transplantation - adverse effects ; Corneal Transplantation - methods ; Dissection ; Dissection - methods ; Endothelium ; Eye surgery ; Female ; Humans ; Keratoconus - surgery ; Male ; Postoperative Complications - etiology ; Retrospective Studies ; Statistical analysis ; Sutures ; Treatment Outcome ; Viscoelasticity</subject><ispartof>American journal of ophthalmology, 2020-04, Vol.212, p.127-133</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-8a381a1c7083a4762dd503a38b476bc9165b4e51e9b7ef817b3eb9c3a4c2b2b33</citedby><cites>FETCH-LOGICAL-c424t-8a381a1c7083a4762dd503a38b476bc9165b4e51e9b7ef817b3eb9c3a4c2b2b33</cites><orcidid>0000-0003-3635-3521 ; 0000-0001-6826-7957 ; 0000-0002-6419-6941</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002939419306130$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31883463$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scorcia, Vincenzo</creatorcontrib><creatorcontrib>Giannaccare, Giuseppe</creatorcontrib><creatorcontrib>Lucisano, Andrea</creatorcontrib><creatorcontrib>Soda, Mauro</creatorcontrib><creatorcontrib>Scalzo, Giovanna Carnovale</creatorcontrib><creatorcontrib>Myerscough, James</creatorcontrib><creatorcontrib>Pellegrini, Marco</creatorcontrib><creatorcontrib>Verdoliva, Francesco</creatorcontrib><creatorcontrib>Piccoli, Gabriele</creatorcontrib><creatorcontrib>Bovone, Cristina</creatorcontrib><creatorcontrib>Busin, Massimo</creatorcontrib><title>Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>To identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity.
Retrospective Cohort Study.
Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019. Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment optical coherence tomography (AS-OCT)–based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro-/macroperforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.
Pneumatic dissection succeeded in 113 of 155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%), and 2 mixed-type (1.8%). Microperforations were managed conservatively in type 1 bubbles; macroperforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P = .006 and P < .013). Type 1 bubbles formed in eyes with significantly lower age, K-mean, and AS-OCT stages and higher pachymetric values (always P < .029). Age had the highest diagnostic power for discrimination between bubble types, followed by AS-OCT stage, pachymetry, K-mean, and astigmatism (respectively, AUC = 0.861, 0.779, 0.748, 0.700, 0.670).
Older age and advanced stages of keratoconus were predictors of type 2 bubble formation during BB-DALK that was associated with an increased risk of complications.</description><subject>Adult</subject><subject>Contact lenses</subject><subject>Cornea</subject><subject>Corneal Transplantation - adverse effects</subject><subject>Corneal Transplantation - methods</subject><subject>Dissection</subject><subject>Dissection - methods</subject><subject>Endothelium</subject><subject>Eye surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Keratoconus - surgery</subject><subject>Male</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Sutures</subject><subject>Treatment Outcome</subject><subject>Viscoelasticity</subject><issn>0002-9394</issn><issn>1879-1891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi1ERZfCA3BBlrhwSeqxs0ksTqVLAXWl9lDE0bKdWXCU2MFOkPbOg-NlFw4cerJ-65tfo_kIeQWsBAb1ZV_qPpScgSyBlwz4E7KCtpEFtBKekhVjjBdSyOqcPE-pz7FuquYZORfQtqKqxYr8uo_YOTuHmGjY0feLMQPSmxBHPbvgqfYdfdhPSO_MrJ3Hjn5183d673E5EJZuXEpo_7CbJTr_jW4QJ3rlZ4wuRLrVIw6DjvQWo57DNOg076nzp2yDX9ILcrbTQ8KXp_eCfLn58HD9qdjeffx8fbUtbMWruWi1aEGDbVgrdNXUvOvWTORPk4OxEuq1qXANKE2DuxYaI9BIm1nLDTdCXJC3x94phh8LplmNLtnDeh7DkhQXAviaSwkZffMf2ocl-ryd4hU0TEgAmSk4UjaGlCLu1BTdqONeAVMHRapXWZE6KFLAVVaUZ16fmhczYvdv4q-TDLw7AphP8dNhVMk69DZ7ivnSqgvukfrft8GiOQ</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Scorcia, Vincenzo</creator><creator>Giannaccare, Giuseppe</creator><creator>Lucisano, Andrea</creator><creator>Soda, Mauro</creator><creator>Scalzo, Giovanna Carnovale</creator><creator>Myerscough, James</creator><creator>Pellegrini, Marco</creator><creator>Verdoliva, Francesco</creator><creator>Piccoli, Gabriele</creator><creator>Bovone, Cristina</creator><creator>Busin, Massimo</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3635-3521</orcidid><orcidid>https://orcid.org/0000-0001-6826-7957</orcidid><orcidid>https://orcid.org/0000-0002-6419-6941</orcidid></search><sort><creationdate>202004</creationdate><title>Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus</title><author>Scorcia, Vincenzo ; Giannaccare, Giuseppe ; Lucisano, Andrea ; Soda, Mauro ; Scalzo, Giovanna Carnovale ; Myerscough, James ; Pellegrini, Marco ; Verdoliva, Francesco ; Piccoli, Gabriele ; Bovone, Cristina ; Busin, Massimo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-8a381a1c7083a4762dd503a38b476bc9165b4e51e9b7ef817b3eb9c3a4c2b2b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Contact lenses</topic><topic>Cornea</topic><topic>Corneal Transplantation - adverse effects</topic><topic>Corneal Transplantation - methods</topic><topic>Dissection</topic><topic>Dissection - methods</topic><topic>Endothelium</topic><topic>Eye surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Keratoconus - surgery</topic><topic>Male</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Sutures</topic><topic>Treatment Outcome</topic><topic>Viscoelasticity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scorcia, Vincenzo</creatorcontrib><creatorcontrib>Giannaccare, Giuseppe</creatorcontrib><creatorcontrib>Lucisano, Andrea</creatorcontrib><creatorcontrib>Soda, Mauro</creatorcontrib><creatorcontrib>Scalzo, Giovanna Carnovale</creatorcontrib><creatorcontrib>Myerscough, James</creatorcontrib><creatorcontrib>Pellegrini, Marco</creatorcontrib><creatorcontrib>Verdoliva, Francesco</creatorcontrib><creatorcontrib>Piccoli, Gabriele</creatorcontrib><creatorcontrib>Bovone, Cristina</creatorcontrib><creatorcontrib>Busin, Massimo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scorcia, Vincenzo</au><au>Giannaccare, Giuseppe</au><au>Lucisano, Andrea</au><au>Soda, Mauro</au><au>Scalzo, Giovanna Carnovale</au><au>Myerscough, James</au><au>Pellegrini, Marco</au><au>Verdoliva, Francesco</au><au>Piccoli, Gabriele</au><au>Bovone, Cristina</au><au>Busin, Massimo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>212</volume><spage>127</spage><epage>133</epage><pages>127-133</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><abstract>To identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity.
Retrospective Cohort Study.
Setting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019. Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment optical coherence tomography (AS-OCT)–based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro-/macroperforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.
Pneumatic dissection succeeded in 113 of 155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%), and 2 mixed-type (1.8%). Microperforations were managed conservatively in type 1 bubbles; macroperforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P = .006 and P < .013). Type 1 bubbles formed in eyes with significantly lower age, K-mean, and AS-OCT stages and higher pachymetric values (always P < .029). Age had the highest diagnostic power for discrimination between bubble types, followed by AS-OCT stage, pachymetry, K-mean, and astigmatism (respectively, AUC = 0.861, 0.779, 0.748, 0.700, 0.670).
Older age and advanced stages of keratoconus were predictors of type 2 bubble formation during BB-DALK that was associated with an increased risk of complications.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31883463</pmid><doi>10.1016/j.ajo.2019.12.012</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-3635-3521</orcidid><orcidid>https://orcid.org/0000-0001-6826-7957</orcidid><orcidid>https://orcid.org/0000-0002-6419-6941</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Contact lenses Cornea Corneal Transplantation - adverse effects Corneal Transplantation - methods Dissection Dissection - methods Endothelium Eye surgery Female Humans Keratoconus - surgery Male Postoperative Complications - etiology Retrospective Studies Statistical analysis Sutures Treatment Outcome Viscoelasticity |
| title | Predictors of Bubble Formation and Type Obtained With Pneumatic Dissection During Deep Anterior Lamellar Keratoplasty in Keratoconus |
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