Novel spatula and dissector for safer deep anterior lamellar keratoplasty

Detalhes bibliográficos
Autor(a) principal: Bonfadini, Gustavo ,2,3
Data de Publicação: 2014
Outros Autores: Kim, Eun Chul, Campos, Mauro Silveira de Queiroz [UNIFESP], Jun, Albert S.
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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spelling 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
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