Papers by Ioannis Aslanides
Investigative Ophthalmology & Visual Science, Jul 22, 2019
Purpose: To present a case of a kidney transplant recipient with multiple, concurrent signs of re... more Purpose: To present a case of a kidney transplant recipient with multiple, concurrent signs of retinal and choroidal microvascular dysfunction following mild coronavirus disease 2019 (COVID-19). Observations: An immunosuppressed, 51-year-old male with a history of kidney transplantation at an earlier stage, presented with bilateral conjunctivitis and blurry vision that coincided with a SARS-CoV-2-positive upper respiratory tract infection. On examination, we observed bilateral vitritis as well as choroidal congestion with signs of outer retinal and inner choroidal microvascular dysfunction. Moreover, cotton wool spots, consistent with inner retinal ischemia were noted while the rest of the clinical findings subsided. Conclusions and importance: COVID-19, a multi-systemic disease that primarily affects the respiratory system, has been associated with a number of seemingly diverse ocular phenotypes, where both inflammation and ischemia seem to play role. Moreover, the presence of unde...
Journal of Ophthalmology, 2020
The novel coronavirus pneumonia COVID-19 is caused by the novel coronavirus SARS-CoV-2, which is ... more The novel coronavirus pneumonia COVID-19 is caused by the novel coronavirus SARS-CoV-2, which is highly contagious, has a long incubation period, and can be detected in patients' tears and conjunctival secretions. In this study, we describe our experience regarding the necessary protective measures that need to be taken during ophthalmic examination and treatment. The authors reviewed the clinical work arrangements during the epidemic situation at the Eye Hospital of Wenzhou Medical University in China and analyzed the prevention and control measures that were applied during the laser corneal refractive surgery process. The comprehensive protection protocol, which was established throughout the entire process, included both horizontal (medical staff-patient, medical staff-medical staff, and patient-patient) and vertical (preoperative, intraoperative, and postoperative transmission assessment) approach and was mainly focused on strengthening the protection against potential aeros...
A bandage contact lenses after transepithelial photorefractive keratectomy
Journal of Cataract and Refractive Surgery, 2021
Patients develop postoperative fibrosis at the site of operation after dacryocystorhinostomy (DCR... more Patients develop postoperative fibrosis at the site of operation after dacryocystorhinostomy (DCR) which results in impairment of the osteum patency. This quasi-experimental study was undertaken to determine the role of intraoperative Mitomycin C (MMC) application in maintaining postoperative patency of the osteum. The present study was conducted at the Eye department of Ayub Medical College, Abbottabad on patients in whom routine DCR was indicated. Subjects were divided into mitomycin C (Test) and non mitomycin C (Control) groups. In test group, Mitomycin C was applied to the anastomosed flaps and osteotomy site for 30 minutes. Postoperative patients were followed for up to 6 months and outcome of patency was documented. A.total of 73 patients were included, divided into test (30) and control (43) groups. An overall success rate of 86.3% was obtained for patent ostia; this was based on 96.67% success in test group compared to 79.1% in the control group (p=0.031). Intraoperative application of Mitomycin-C significantly improves the success rate in external dacryocystorhinostomy.
Surgery Today
Maps of the corneal epithelium can be valuable in the decision-making process for excimer laser c... more Maps of the corneal epithelium can be valuable in the decision-making process for excimer laser corneal refractive surgery, in the assessment of short-and long-term postoperative outcomes and epithelial healing after corneal collagen crosslinking (CXL), and in screening for keratoconus and pellucid mar-ginal degeneration (PMD). Reinstein et al have contributed a large number of studies with ultrasound epithelial mea-surements pointing out the plasticity of the epithelium in keratoconic corneas; they have suggested that a thicker than normal central cornea epithelium may suggest ectasia, as it may reflect the thickening normalization response to infe-rior steepening commonly seen in ectasia. Current optically based corneal imaging systems have limited capability to discern epithelial from stromal com-ponents over the entire corneal area. On the other hand, in vivo visualization of the epithelial layer over the stromal bed can be achieved using the principle of reflecting an elastic w...
Journal of Refractive Surgery, 2010
PURPOSE: To assess the effi cacy, predictability, and safety of LASIK for the surgical correction... more PURPOSE: To assess the effi cacy, predictability, and safety of LASIK for the surgical correction of low to moderate myopia with astigmatism using the SCHWIND AMARIS excimer laser.
Journal of Cataract and Refractive Surgery, 1995
Radial keratotomy is a surgical procedure to correct myopia that involves placing corneal incisio... more Radial keratotomy is a surgical procedure to correct myopia that involves placing corneal incisions of precise partial thickness to induce flattening. It has yielded positive but sometimes unpredictable results. Many surgical variables influence the final result. Among them, incision depth is probably the most difficult to control and evaluate. In this study, we used very high frequency (50 MHz) ultrasound (HFU) to image radial keratotomy incisions in post-radial keratotomy human corneas to obtain high definition images of the cornea. The images allowed us to measure the depth of incisions as a percentage of corneal thickness.
Clinical Ophthalmology, 2012
To determine and correlate epithelial corneal thickness (pachymetric) measurements taken with a d... more To determine and correlate epithelial corneal thickness (pachymetric) measurements taken with a digital arc scanning very high frequency ultrasound biomicroscopy (HF UBM) imaging system (Artemis-II), and compare mean and central epithelial thickness among normal eyes, untreated keratoconic eyes, and keratoconic eyes previously treated with collagen crosslinking (CXL). Methods: Epithelial pachymetry measurements (topographic mapping) were conducted on 100 subjects via HF UBM. Three groups of patients were included: patients with normal eyes (controls), patients with untreated keratoconic eyes, and patients with keratoconic eyes treated with CXL. Central, mean, and peripheral corneal epithelial thickness was examined for each group, and a statistical study was conducted. Results: Mean, central, and peripheral corneal epithelial thickness was compared between the three groups of patients. Epithelium thickness varied substantially in the keratoconic group, and in some cases there was a difference of up to 20 µm between various points of the same eye, and often a thinner epithelium coincided with a thinner cornea. However, on average, data from the keratoconic group suggested an overall thickening of the epithelium, particularly over the pupil center of the order of +3 µm, while the mean epithelium thickness was on average +1.1 µm, compared to the control population (P = 0.005). This overall thickening was more pronounced in younger patients in the keratoconic group. Keratoconic eyes previously treated with CXL showed, on average, virtually the same average epithelium thickness (mean-0.7 µm,-0.2 µm over the pupil center,-0.9 µm over the peripheral zone) as the control group. This finding further reinforces our novel theory of the "reactive" component of epithelial thickening in corneas that are biomechanically unstable, becoming stable when biomechanical rigidity is accomplished despite persistence of cornea topographic irregularity. Conclusion: A highly irregular epithelium may be suggestive of an ectatic cornea. Our results indicate that the epithelium is thinner over the keratoconic protrusion, but to a much lesser extent than anticipated, and on average epithelium is thicker in this group of patients. This difference appears to be clinically significant and may become a screening tool for eyes suspected for ectasia.
Expert Opinion on Drug Safety, 2006
Mitomycin C is a chemotherapeutic agent that acts by inhibiting DNA synthesis. Its use and applic... more Mitomycin C is a chemotherapeutic agent that acts by inhibiting DNA synthesis. Its use and application in ophthalmology has been increasing in recent years because of its modulatory effects on wound healing. Current applications include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.
Contact Lens and Anterior Eye, 2008
Purpose: To report a case of airbag induced corneal ectasia. Methods: Case report. Results: A pat... more Purpose: To report a case of airbag induced corneal ectasia. Methods: Case report. Results: A patient 3 years post-LASIK developed bilateral corneal ectasia worse in the right eye following airbag deployment in a road traffic accident. At last follow up, best corrected vision was 20/40 with À4.00/À4.00 Â 25 in the right eye and 20/25 with À1.25/À0.50 Â 135 in the left eye. Conclusions: This is a rare presentation of trauma induced ectasia in a patient post-LASIK. It is possible that reduction in biomechanical integrity of the cornea from prior refractive surgery contributed to this presentation.
Astigmatism - Optics, Physiology and Management, 2012
Journal of Refractive Surgery, 2012
To evaluate the long-term outcomes of aspheric corneal wavefront ablation profiles for excimer la... more To evaluate the long-term outcomes of aspheric corneal wavefront ablation profiles for excimer laser retreatment. Eighteen eyes that had previously undergone LASIK or photorefractive keratectomy (PRK) were retreated with LASIK using the corneal wavefront ablation profile. Custom Ablation Manager (SCHWIND eye-tech-solutions, Kleinostheim, Germany) software and the ESIRIS flying spot excimer laser system (SCHWIND) were used to perform the ablations. Refractive outcomes and wavefront data are reported up to 4 years after retreatment. Pre- and postoperative data were compared with Student t tests and (multivariate) correlation tests. P<.05 was considered statistically significant. A bilinear correlation of various postoperative wavefront aberrations versus planned correction and preoperative aberration was performed. Mean manifest refraction spherical equivalent (MRSE) before retreatment was -0.38±1.85 diopters (D) and -0.09±0.22 D at 6 months and -0.10±0.38 D at 4 years postoperatively. The reduction in MRSE was statistically significant at both postoperative time points (P<.005). Postoperative aberrations were statistically lower (spherical aberration P<.05; coma P<.005; root-mean-square higher order aberration P<.0001) at 4 years postoperatively. Distribution of the postoperative uncorrected distance visual acuity (P<.0001) and corrected distance visual acuity (P<.01) were statistically better than preoperative values. Aspheric corneal wavefront customization with the ESIRIS yields visual, optical, and refractive results comparable to those of other wavefront-guided customized techniques for the correction of myopia and myopic astigmatism. The corneal wavefront customized approach shows its strength in cases where abnormal optical systems are expected. Systematic wavefront customized corneal ablation appears safe and efficacious for retreatment cases.
Contact Lens and Anterior Eye, 2011
To compare the refractive and visual outcomes using the Schwind Amaris excimer laser in patients ... more To compare the refractive and visual outcomes using the Schwind Amaris excimer laser in patients with high astigmatism (>1 D) with and without the static cyclotorsion compensation (SCC) algorithm available with this new laser platform. Methods: 70 consecutive eyes with ≥1 D astigmatism were randomized to treatment with compensation of static cyclotorsion (SCC group-35 eyes) or not (control group-35 eyes). A previously validated optimized aspheric ablation algorithm profile was used in every case. All patients underwent LASIK with a microkeratome cut flap. Results: The SCC and control group did not differ preoperatively, in terms of refractive error, magnitude of astigmatism or in terms of cardinal or oblique astigmatism. Following treatment, average deviation from target was SEq +0.16 D, SD ± 0.52 D, range −0.98 D to +1.71 D in the SCC group compared to +0.46 D, SD ± 0.61 D, range −0.25 D to +2.35 D in the control group, which was statistically significant (p < 0.05). Following treatment, average astigmatism was 0.24 D (SD ± 0.28 D, range −1.01 D to 0.00 D) in the SCC group compared to 0.46 D (SD ± 0.42 D, range −1.80 D to 0.00 D) in the control group, which was highly statistically significant (p < 0.005). There was no statistical difference in the postoperative uncorrected vision when the aspheric algorithm was used although there was a trend to increased number of lines gained in the SCC group. Conclusions: This study shows that static cyclotorsion is accurately compensated for by the Schwind Amaris laser platform. The compensation of static cyclotorsion in patients with moderate astigmatism produces a significant improvement in refractive and astigmatic outcomes than when not compensated.
Clinical Ophthalmology, 2012
To evaluate postoperative pain, corneal epithelial healing, development of corneal haze, refracti... more To evaluate postoperative pain, corneal epithelial healing, development of corneal haze, refractive outcomes, and corneal aberrations in a novel one-step, modified transepithelial photorefractive keratectomy (PRK), termed All-surface laser ablation (ASLA), compared to conventional, alcohol-assisted PRK. Materials and methods: Sixty eyes of 30 myopic patients were prospectively recruited to a randomized fellow eye study. Patients underwent conventional alcohol-assisted PRK in one eye (control group) and ASLA-modified transepithelial PRK in the other (30 eyes in each treatment arm). Primary endpoints were postoperative pain and haze scores at 1 day, 3 days, 1 week, and 1, 3, 6, and 12 months. Secondary endpoints included visual acuity at 1, 3, 6, and 12 months, corneal aberrations at 3, 6, and 12 months, and early and late onset haze. Refractive predictability, safety, and efficacy of the two methods were considered. Results: The average age of the cohort was 29 years (standard deviation [SD]: 9; range: 18-46), and the average spherical equivalent refractive error was −4.18 diopters (SD: 1.9). At 3 days after surgery, the average pain score was 64% lower in the ASLA group (P , 0.0005). At this point, 96% of ASLA eyes had no epithelial defect, whereas 43% in the alcohol-assisted group did not achieve complete epithelial healing, and required replacement of bandage contact lens. The haze level was consistently lower in the ASLA group at all time points from 1 to 6 months. Conclusion: This study shows that the ASLA technique may have a future role in refractive surgery, due to the fact that it offers faster epithelial healing, lower pain scores, and significantly less haze formation.
Journal of Refractive Surgery, 2005
PURPOSE: To determine the possible impact of conductive keratoplasty (CK) on intraocular pressure... more PURPOSE: To determine the possible impact of conductive keratoplasty (CK) on intraocular pressure (IOP) measurements. METHODS: A prospective, single-center, noncomparative interventional case series was performed. Baseline and postoperative IOPs were measured by Goldmann applanation tonometry in 32 eyes of 18 patients who underwent CK for hyperopia correction. Mean follow-up was 11.9 months (range: 8 to 18 months).
Journal of Refractive Surgery, 2004
To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive ke... more To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive keratoplasty. A 48-year-old man underwent conductive keratoplasty for low hyperopic astigmatism (manifest refraction OD: +2.25 -0.50 x 77 degrees; OS: +2.50 -0.50 x 105 degrees). Three months postoperatively, UCVA was 20/25 and BSCVA was 20/20 in both eyes; manifest refraction OD: -0.25 -0.75 x 110 degrees; OS: +0.75 -0.75 x 50 degrees. Sixteen months after the operation, regression of refractive outcome was (manifest) OD: +1.75 -1.25 x 90 degrees; OS: +2.50 -0.50 x 85 degrees; UCVA was 20/40 in the right eye and 20/63 in the left eye and BSCVA was 20/20 in both eyes. LASIK was performed for hyperopic regression in the left eye using an automated microkeratome (Alcon SKBM, 130-microm plate; Aesculap-Meditec MEL 70 excimer laser). LASIK was uneventful and no intraoperative or postoperative complications related to the previous conductive keratoplasty procedure or LASIK were observed. Three months after LASIK and 19 months after the initial conductive keratoplasty, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s left eye was emmetropic; UCVA was 20/20(-2), BSCVA was 20/20 and manifest refraction was +0.25 -0.25 x 35 degrees. There was a uniform increase in topographical steepening. Visual acuity, refraction and topographic findings remained unchanged at 6 months. Even though our experience is limited, treatment of hyperopia with LASIK in an eye with refractive regression following previous conductive keratoplasty resulted in a predicted refractive outcome, with no complications, and improvement in visual acuity at 6 months follow-up.
Journal of Refractive Surgery, 2007
PURPOSE: To evaluate the accuracy and consistency of corneal fl ap thickness, horizontal diameter... more PURPOSE: To evaluate the accuracy and consistency of corneal fl ap thickness, horizontal diameter, and hinge size with the Moria M2 90-µm single use head (Moria, Antony, France). METHODS: Fifty-two myopic patients (104 eyes), mean age 32.6 years, underwent bilateral LASIK with a superior hinged fl ap using the Moria M2 microkeratome (90µm single use head). Prospective evaluation included fl ap thickness (subtraction method), diameter, hinge size, interface particles, intraoperative complications, and visual recovery. RESULTS: The mean preoperative spherical equivalent refraction was Ϫ5.72Ϯ2.59 diopters (D) (range: Ϫ2.88 to Ϫ10.75 D) and Ϫ5.84Ϯ2.73 D (range: Ϫ3.13 to Ϫ9.38 D) for right and left eyes, respectively. The mean preoperative central pachymetry was 548Ϯ24 µm and 547Ϯ25 µm for right and left eyes, respectively. The mean preoperative steepest K was 44.12Ϯ1.28 D and 44.41Ϯ1.27 D for right and left eyes, respectively. Corneal diameter (white to white) was 12Ϯ0.4 mm and 11.9Ϯ0.4 mm for right and left eyes, respectively. The mean postoperative fl ap thickness was 109Ϯ18 µm (range: 67 to 152 µm) and 103Ϯ15 µm (range: 65 to 151 µm) for right and left eyes, respectively. The mean postoperative fl ap diameter was 9.4Ϯ0.3 mm (expected mean according to the nomogram given by the company was 9.5 mm). The mean postoperative hinge chord was 4.4Ϯ0.4 mm (expected mean 4.2 mm). No interface particles were detected on slit-lamp examination. CONCLUSIONS: The Moria M2 90-µm single use head is safe with good predictability for LASIK fl ap creation. [
Uploads
Papers by Ioannis Aslanides