Browsing by Author "Gatinel, Damien"

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    Current concepts in the management of cataract with keratoconus
    (Wolters Kluwer – Medknow, 2024-04) Nicholson, Maneck; Singh, Vivek M; Murthy, Somasheila; Gatinel, Damien; Pereira, Savio; Pradhan, Aditya; Vasavada, Shail; Dandekar, Prajakta; Naik, Mekhla; Sharma, Supriya
    This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross?linking, intrastromal corneal ring segments, and topo?guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.
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    Ten years of Descemet membrane endothelial keratoplasty: Identifying risk factors and early failure signs
    (Wolters Kluwer – Medknow, 2025-07) Mechleb, Nicole; Rizk, Maria; Debellemanière, Guillaume; Gatinel, Damien; Saad, Alain
    Purpose: To evaluate the effect of surgical indications and complexity on long?term clinical outcomes in Descemet membrane endothelial keratoplasty (DMEK) and identify early signs of graft failure. Design: Retrospective case series of 105 patients who underwent DMEK from March 2012 to December 2014. Methods: Surgical results were analyzed at 1 year, 3 years, 5 years, and 10 years based on surgical indication: fuchs endothelial dystrophy (FECD) (n = 47) and bullous keratopathy (BK) (n = 58), and on the presence of anterior segment comorbidities: simple (n = 63) versus complex (n = 42) DMEK. Results: Fifty?two patients (54 eyes) were followed up for 3 years, 35 patients (42 eyes) reached the 5?year follow?up, and 20 patients (26 eyes) achieved the 10?year follow?up. Simple DMEK procedures and FECD demonstrated significantly better best corrected visual acuity (BCVA) compared to complex DMEK and BK at 1 year, 3 years, 5 years, and 10 years, respectively (P < 0.01). No statistically significant difference in endothelial cell density (ECD) decline was noted between simple and complex DMEK procedures, nor between FECD and BK (P > 0.05). Central and peripheral pachymetry were significantly higher in BK and complex surgeries at 10 years. Conclusion: While DMEK represents a promising therapeutic avenue for corneal decompensation alongside anterior segment comorbidities, extended follow?up indicates a rise in central and peripheral pachymetry in comparison with simple DMEK. This increase could serve as an early indicators of corneal decompensation, potentially leading to reduced survival rates.