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      Semi-Autologous Corneal Transplantation with Simultaneous Bilateral Surgery: A Case Report

      case-report

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          Abstract

          The present report describes a case of semi-autologous corneal transplantation with bilateral surgery using two operating microscopes simultaneously. An 86-year-old man with history of six prior failed penetrating keratoplasties in his right eye presented with decreased vision. His other eye was deeply amblyopic but had a clear 30-year-old Castroviejo-square graft with an endothelial cell count of 803 cells/mm 2. A semi-autologous graft was performed from the left eye to the right. Surgery was performed simultaneously on both eyes by two different surgeons using a standard ophthalmic operating microscope as well as a second ENT microscope. Upon trephination of the right failed corneal graft, vitreous opacities were noted and sent for culture. The semi-autologous tissue was directly transferred from the left eye to the right without any storage in preservation media to avoid endothelial cell loss. The semi-autologous graft remained clear in the immediate postoperative period. However, the vitreous cultures grew coagulase-negative Staphylococcus. Despite all efforts, the patient eventually developed a retinal detachment and vision in the right eye decreased to light perception. Autologous penetrating keratoplasty is an option for patients with loss of corneal function in a potentially seeing eye and a clear cornea in a contralateral eye with poor visual potential due to non-corneal disease. This case is unique in that part of the autologous penetrating keratoplasty had an old square graft in the center and corneal transplant surgery was done simultaneously in both eyes. It also highlights chronic indolent endophthalmitis as a potential cause of multiple graft failures.

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          Most cited references25

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          Endophthalmitis After Penetrating Keratoplasty

          To determine the incidence of endophthalmitis after penetrating keratoplasty (PK) and patient and donor risk factors.
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            • Article: not found

            The suitability of corneas stored by organ culture for penetrating keratoplasty and influence of donor and recipient factors on 5-year graft survival.

            To determine the impact of donor factors on the suitability of corneas stored by organ culture for penetrating keratoplasty (PK) and the influence of donor and recipient factors on 5-year survival of first PK.
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              Is Open Access

              Comprehensive review of surgical microscopes: technology development and medical applications

              Abstract. Significance: Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery. Aim: This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications. Approach: More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described. Results: Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room. Conclusions: The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.
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                Author and article information

                Journal
                Case Rep Ophthalmol
                Case Rep Ophthalmol
                COP
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Basel, Switzerland )
                1663-2699
                12 September 2023
                Jan-Dec 2023
                12 September 2023
                : 14
                : 1
                : 439-447
                Affiliations
                [a ]Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                [b ]2nd Eye Clinic, “Ophthalmiatrion Athinon,” Athens, Greece
                [c ]Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
                Author notes
                Correspondence to: Sotiria Palioura, sotiria.palioura@ 123456gmail.com

                Nefeli E. Kounatidou and Dimitra Kopsini contributed equally to this work.

                Article
                531990
                10.1159/000531990
                10601773
                37901627
                afaee83a-52cb-4bd9-bdbe-fc2f83b733d9
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 10 April 2023
                : 29 June 2023
                : 2023
                Page count
                Figures: 5, Tables: 1, References: 25, Pages: 9
                Funding
                Supported by the NIH Center Core Grant (P30EY014801) and the Research to Prevent Blindness Unrestricted Grant (GR004596-1).
                Categories
                Case Report

                autokeratoplasty,autologous penetrating keratoplasty,repeat penetrating keratoplasty,graft survival,chronic endophthalmitis

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