Novel spatula and dissector for safer deep anterior lamellar keratoplasty
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.5935/0034-7280.20140060 http://repositorio.unifesp.br/handle/11600/8608 |
Resumo: | Objective: We describe a novel spatula and dissector to facilitate the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Methods: A 29-year-old man who was diagnosed with bilateral keratoconus underwent deep anterior lamellar keratoplasty (DALK). After 350μm partial thickness incision of the recipient cornea, the Bonfadini dissector was inserted at the deepest point in the peripheral incision and could be advanced to the center of the cornea safely because of its semi-sharp tip. After achieving the big-bubble (BB) separation of Descemet membrane (DM) from the overlying stroma, the anterior stromal disc was removed. Viscoelastic material was placed on the stromal bed to prevent uncontrolled collapse and perforation of DM during the paracentesis blade incision into the BB. We could detect the safe opening of the BB using the Bonfadini dissector by the leakage of air bubbles into the viscoelastic material. After injecting viscoelastic material into the BB space, we inserted the Bonfadini spatula into the bigbubble safely because of its curved profile and blunt edges. The groove along the length of the Bonfadini spatula enables safe and efficient incision or the residual stromal tissue using the pointed end of a sharp blade while protecting the underlying DM. After removal of posterior stroma, the donor button was sutured with 16 interrupted 10-0 nylon sutures. Results: This technique and the use of the Bonfadini spatula and dissector facilitate exposure of Descemet membrane. Conclusion: The smooth Bonfadini DALK spatula and dissector facilitate safe and efficient completion of DALK surgery. |
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Novel spatula and dissector for safer deep anterior lamellar keratoplastyUso de espátula e dissector para otimização da ceratoplastia lamelar anterior profunda (DALK)Deep anterior lamellar keratoplastyCorneal transplantation/methodsKeratoplastyBonfadini dissectorBonfadini spatulaCeratoplastia lamelar anterior profundaTransplante de córnea/métodosCeratoplastiaDissector BonfadiniEspátula BonfadiniObjective: We describe a novel spatula and dissector to facilitate the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Methods: A 29-year-old man who was diagnosed with bilateral keratoconus underwent deep anterior lamellar keratoplasty (DALK). After 350μm partial thickness incision of the recipient cornea, the Bonfadini dissector was inserted at the deepest point in the peripheral incision and could be advanced to the center of the cornea safely because of its semi-sharp tip. After achieving the big-bubble (BB) separation of Descemet membrane (DM) from the overlying stroma, the anterior stromal disc was removed. Viscoelastic material was placed on the stromal bed to prevent uncontrolled collapse and perforation of DM during the paracentesis blade incision into the BB. We could detect the safe opening of the BB using the Bonfadini dissector by the leakage of air bubbles into the viscoelastic material. After injecting viscoelastic material into the BB space, we inserted the Bonfadini spatula into the bigbubble safely because of its curved profile and blunt edges. The groove along the length of the Bonfadini spatula enables safe and efficient incision or the residual stromal tissue using the pointed end of a sharp blade while protecting the underlying DM. After removal of posterior stroma, the donor button was sutured with 16 interrupted 10-0 nylon sutures. Results: This technique and the use of the Bonfadini spatula and dissector facilitate exposure of Descemet membrane. Conclusion: The smooth Bonfadini DALK spatula and dissector facilitate safe and efficient completion of DALK surgery.Objetivo: Descrevemos o uso de novos instrumentais cirúrgicos para facilitar a técnica de big-bubble na ceratoplastia lamelar anterior profunda (DALK). Métodos: Paciente masculino, 29 anos, foi diagnosticado com ceratocone bilateral e submetido à ceratoplastia lamelar anterior profunda (DALK). Após incisão da córnea receptora numa profundidade de 350μm de espessura parcial, o dissector Bonfadini foi inserido no ponto mais profundo da incisão periférica e pode avançar para o centro da córnea com segurança devido à sua ponta semiafiada. Depois de realizar a big-bubble (BB) e atingir a separação da Membrana de Descemet (MD) do estroma sobrejacente, o disco corneano de estroma anterior foi removido. Um viscoelástico foi colocado sobre o leito do estroma remanescente para impedir o colapso não-controlado e perfuração da MD durante a incisão na BB com lâmina de paracentese. Verificamos segurança no rompimento do estroma remanescente com o auxílio do dissector Bonfadini, para liberação da bolha de ar da BB através do viscoelástico. Depois de injetar o viscoelástico no espaço da BB, inserimos a espátula Bonfadini neste espaço, o que demonstrou-se seguro devido ao formato curvo e das bordas arredondadas do instrumental. A chanfradura ao longo do comprimento da espátula Bonfadini permite a incisão pela ponta de uma lâmina afiada, protegendo assim a MD subjacente. Após a remoção do estroma posterior, o botão doador foi suturado com 16 pontos interrompidos de fio nylon 10.0. Resultados: Esta técnica e o uso da espátula Bonfadini e dissector facilitam a exposição de membrana de Descemet. Conclusão: A superfície lisa da espátula Bonfadini e dissector, facilitam a realização segura e eficiente da ceratoplastia lamelar anterior profunda (DALK).Johns Hopkins School of Medicine Wilmer Eye Institute Cornea & Anterior Segment ServiceRio de Janeiro Eye BankUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaCatholic University of Korea College of MedicineUNIFESP, EPMSciELOSociedade Brasileira de OftalmologiaJohns Hopkins School of Medicine Wilmer Eye Institute Cornea & Anterior Segment ServiceRio de Janeiro Eye BankUniversidade Federal de São Paulo (UNIFESP)Catholic University of Korea College of MedicineBonfadini, Gustavo ,2,3Kim, Eun ChulCampos, Mauro Silveira de Queiroz [UNIFESP]Jun, Albert S.2015-06-14T13:47:19Z2015-06-14T13:47:19Z2014-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion279-281application/pdfhttp://dx.doi.org/10.5935/0034-7280.20140060Revista Brasileira de Oftalmologia. Sociedade Brasileira de Oftalmologia, v. 73, n. 5, p. 279-281, 2014.10.5935/0034-7280.20140060S0034-72802014000500279.pdf0034-7280S0034-72802014000500279http://repositorio.unifesp.br/handle/11600/8608engRevista Brasileira de Oftalmologiainfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-07-29T13:31:07Zoai:repositorio.unifesp.br/:11600/8608Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-07-29T13:31:07Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty Uso de espátula e dissector para otimização da ceratoplastia lamelar anterior profunda (DALK) |
title |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
spellingShingle |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty Bonfadini, Gustavo ,2,3 Deep anterior lamellar keratoplasty Corneal transplantation/methods Keratoplasty Bonfadini dissector Bonfadini spatula Ceratoplastia lamelar anterior profunda Transplante de córnea/métodos Ceratoplastia Dissector Bonfadini Espátula Bonfadini |
title_short |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
title_full |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
title_fullStr |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
title_full_unstemmed |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
title_sort |
Novel spatula and dissector for safer deep anterior lamellar keratoplasty |
author |
Bonfadini, Gustavo ,2,3 |
author_facet |
Bonfadini, Gustavo ,2,3 Kim, Eun Chul Campos, Mauro Silveira de Queiroz [UNIFESP] Jun, Albert S. |
author_role |
author |
author2 |
Kim, Eun Chul Campos, Mauro Silveira de Queiroz [UNIFESP] Jun, Albert S. |
author2_role |
author author author |
dc.contributor.none.fl_str_mv |
Johns Hopkins School of Medicine Wilmer Eye Institute Cornea & Anterior Segment Service Rio de Janeiro Eye Bank Universidade Federal de São Paulo (UNIFESP) Catholic University of Korea College of Medicine |
dc.contributor.author.fl_str_mv |
Bonfadini, Gustavo ,2,3 Kim, Eun Chul Campos, Mauro Silveira de Queiroz [UNIFESP] Jun, Albert S. |
dc.subject.por.fl_str_mv |
Deep anterior lamellar keratoplasty Corneal transplantation/methods Keratoplasty Bonfadini dissector Bonfadini spatula Ceratoplastia lamelar anterior profunda Transplante de córnea/métodos Ceratoplastia Dissector Bonfadini Espátula Bonfadini |
topic |
Deep anterior lamellar keratoplasty Corneal transplantation/methods Keratoplasty Bonfadini dissector Bonfadini spatula Ceratoplastia lamelar anterior profunda Transplante de córnea/métodos Ceratoplastia Dissector Bonfadini Espátula Bonfadini |
description |
Objective: We describe a novel spatula and dissector to facilitate the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Methods: A 29-year-old man who was diagnosed with bilateral keratoconus underwent deep anterior lamellar keratoplasty (DALK). After 350μm partial thickness incision of the recipient cornea, the Bonfadini dissector was inserted at the deepest point in the peripheral incision and could be advanced to the center of the cornea safely because of its semi-sharp tip. After achieving the big-bubble (BB) separation of Descemet membrane (DM) from the overlying stroma, the anterior stromal disc was removed. Viscoelastic material was placed on the stromal bed to prevent uncontrolled collapse and perforation of DM during the paracentesis blade incision into the BB. We could detect the safe opening of the BB using the Bonfadini dissector by the leakage of air bubbles into the viscoelastic material. After injecting viscoelastic material into the BB space, we inserted the Bonfadini spatula into the bigbubble safely because of its curved profile and blunt edges. The groove along the length of the Bonfadini spatula enables safe and efficient incision or the residual stromal tissue using the pointed end of a sharp blade while protecting the underlying DM. After removal of posterior stroma, the donor button was sutured with 16 interrupted 10-0 nylon sutures. Results: This technique and the use of the Bonfadini spatula and dissector facilitate exposure of Descemet membrane. Conclusion: The smooth Bonfadini DALK spatula and dissector facilitate safe and efficient completion of DALK surgery. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-10-01 2015-06-14T13:47:19Z 2015-06-14T13:47:19Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.5935/0034-7280.20140060 Revista Brasileira de Oftalmologia. Sociedade Brasileira de Oftalmologia, v. 73, n. 5, p. 279-281, 2014. 10.5935/0034-7280.20140060 S0034-72802014000500279.pdf 0034-7280 S0034-72802014000500279 http://repositorio.unifesp.br/handle/11600/8608 |
url |
http://dx.doi.org/10.5935/0034-7280.20140060 http://repositorio.unifesp.br/handle/11600/8608 |
identifier_str_mv |
Revista Brasileira de Oftalmologia. Sociedade Brasileira de Oftalmologia, v. 73, n. 5, p. 279-281, 2014. 10.5935/0034-7280.20140060 S0034-72802014000500279.pdf 0034-7280 S0034-72802014000500279 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Revista Brasileira de Oftalmologia |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
279-281 application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Oftalmologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Oftalmologia |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
_version_ |
1814268311580442624 |