surgical treatment options in congenital aniridia · surgical treatment options in congenital...
TRANSCRIPT
![Page 1: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/1.jpg)
Surgical Treatment Options in Congenital Aniridia –
Cataracts, Glaucomas, Corneal Opacities
Berthold Seitz
UniversitUniversitäätsklinikum des Saarlandes tsklinikum des Saarlandes UKSUKSKlinik fKlinik füür Augenheilkunde, Homburg/Saarr Augenheilkunde, Homburg/Saar
Direktor: Prof. Dr. med. Berthold Seitz, ML, FEBODirektor: Prof. Dr. med. Berthold Seitz, ML, FEBO
![Page 2: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/2.jpg)
Unsere Augen – das Tor zur Welt
UniversitUniversitäätsklinikum des Saarlandes tsklinikum des Saarlandes UKSUKSKlinik fKlinik füür Augenheilkunde, Homburg/Saarr Augenheilkunde, Homburg/Saar
Direktor: Prof. Dr. med. Berthold Seitz, ML, FEBODirektor: Prof. Dr. med. Berthold Seitz, ML, FEBO
![Page 3: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/3.jpg)
Surgical Treatment Options in Aniridia
![Page 4: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/4.jpg)
Surgical Treatment Options in Aniridia
![Page 5: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/5.jpg)
Surgical Treatment Options in Aniridia
� Incidence: 1:64.000 – 1:96.000
� Decreased acitivity of PAX6 geneon chromosome 11p13
� 2/3 autosomal dominant inherited
� Wilms tumor predisposition (sporadic)
Basics in Aniridia
![Page 6: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/6.jpg)
Surgical Treatment Options in Aniridia
� Cornea� Iris� Lens � Chamber Angle (Glaucoma)
� Fovea� Papilla
Defective Ocular Tissues in Aniridia
>> Low Vision>> Nystagmus
![Page 7: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/7.jpg)
Anatomy of the Eye
Surgical Treatment Options in Aniridia
![Page 8: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/8.jpg)
Reversible Blindness vs. Irreversible Blindness(Cornea, Lens , Vitreous) (Optic Nerve , Retina, Brain)
CataractCorneal Opacities
Glaucoma
Surgical Treatment Options in Aniridia
![Page 9: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/9.jpg)
Surgical Treatment Options in Aniridia
There are no straight-forwardgenerally accepted
treatment modalities !!
Aniridia is an Orphan Disease
![Page 10: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/10.jpg)
Typical Patient‘s Records
Surgical Treatment Options in Aniridia
![Page 11: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/11.jpg)
Typical Patient‘s Course of Disease - PF
Surgical Treatment Options in Aniridia
15.11.2001: Date of birth04.04.2003: Date of first presentation - VA OD/OS 0.05-0.1
- congenital total aniridia- macula hypoplasia- nystagmus- hyperopia astigmatism- aniridia associated glaucoma
07.11.2007: OD/OS CPK07.01.2009: OD/OS CPK03.03.2010: OD/OS CPK30.03.2010: OD Phaco + Morcher black iris diaphragm IOL27.07.2010: OD ppVy with removal of fibrous membrane, hyopotony25.04.2013: last visit - VA OD LP, OS0.1
![Page 12: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/12.jpg)
Typical Patient‘s Course of Disease - SW
Surgical Treatment Options in Aniridia
03.11.1986: Date of birth10.03.1987: Date of first presentation
- congenital partial aniridia- macula hypoplasia- nystagmus
14.06.1993: Incipient subcapsular cataract21.11.1996: OD Phaco + Morcher black iris diaphragm IOL28.11.1996: OS Phaco + Morcher black iris diaphragm IOL20.02.1997: OD ppVy with removal secondary cataract08.05.2001: OS Ahmed valve glaucoma surgery12.09.2001: OD Ahmed valve galucoma surgery22.08.2011: OS CPK25/26.10.2012: OD/OS CPK12.03.13: last visit: VA OD/OS 1/50 LT in 1 m
![Page 13: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/13.jpg)
![Page 14: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/14.jpg)
Major Treatment Problems
Glaucomas ~ 50%Late childhood
Brunner SC, Walton DS, Chen TC: Aniridia. Int Ophthalmol Clinics 2008; 48 (2): 79-85
Surgical Treatment Options in Aniridia
![Page 15: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/15.jpg)
![Page 16: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/16.jpg)
� Obscuration of trabecular meshwork and limbal spur
by tissue strands containing blood vessels
� Rudimentary iris plane prallel to the axis of the eye
� Absence of Schlemm‘s canal
Pathophysiology of Aniridic Glaucomas
Surgical Treatment Options in Aniridia
![Page 17: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/17.jpg)
Chamber Angle
Surgical Treatment Options in Aniridia
![Page 18: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/18.jpg)
congenitalcongenital
BuphthalmusBuphthalmus
with congenital anomalies
AniridieAxenfeld-Rieger SyndromSturge-Weber Syndrom
Marfan-Syndrom
with congenital anomalies
AniridieAxenfeld-Rieger SyndromSturge-Weber Syndrom
Marfan-Syndrom
Glaucomas in Children
Ninios K, Jonescu-Cuypers CP, Seitz B: Glaukome bei primären Irisveränderungen - Axenfeld-Rieger-Syndrom, ICE-Syndrome (essenzielle Irisatrophie, Chandler-Syndrom, Cogan-Reese-Syndrom), Aniridie. Ophthalmologe 2011; 108:585-593
Surgical Treatment Options in Aniridia
![Page 19: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/19.jpg)
Surgical Treatment Options in Aniridia
Aniridic Glaucoma
![Page 20: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/20.jpg)
Glaucoma Diagnostics
3 Approaches3 Approaches
IOPIOPMorphology of Optic Nerve Head
Morphology of Optic Nerve Head
Visual FieldsVisual Fields
Surgical Treatment Options in Aniridia
![Page 21: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/21.jpg)
GonioscopySurgical Treatment Options in Aniridia
![Page 22: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/22.jpg)
IOP MeasurementApplanation tonometry
GoldmannImpression tonometry
Schiötz
Surgical Treatment Options in Aniridia
Icare tonometer
![Page 23: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/23.jpg)
IOP Measurement
Surgical Treatment Options in Aniridia
Always measure corneal thickness !Mean: 631 ± 51 µm 1
691 ± 75 µm 2
1 Brandt JD, Casuso LA, Budenz DL: Markedly increased central corneal thickness: an unrecognized finding in congenital aniridia. Am J Ophthalmol 2004; 137:348-350
2 Whitson JT, Liang C, Godfrey DG, Petroll VM, Cavanagh HD, Patel D, Fellman RL, Starita RJ: Central corneal thickness in patients with congenital aniridia. Eye Contact Lens 2005; 31:221-224
![Page 24: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/24.jpg)
Optic Nerve Head
Surgical Treatment Options in Aniridia
![Page 25: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/25.jpg)
Surgical Treatment Options in Aniridia
Optic Nerve Head
![Page 26: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/26.jpg)
Aniridic Glaucoma
Surgical Treatment Options in Aniridia
![Page 27: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/27.jpg)
Documentation of Optic Nerve Head
Surgical Treatment Options in Aniridia
![Page 28: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/28.jpg)
Visual Fields
Surgical Treatment Options in Aniridia
![Page 29: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/29.jpg)
Glaucoma Early Stage
Surgical Treatment Options in Aniridia
Visual Fields
![Page 30: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/30.jpg)
Glaucoma Late Stage
Surgical Treatment Options in Aniridia
Visual Fields
![Page 31: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/31.jpg)
Topical Antiglaucomatous Therapy
Surgical Treatment Options in Aniridia
![Page 32: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/32.jpg)
Surgical Treatment Options in Aniridia
Topical Antiglaucomatous Therapy
![Page 33: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/33.jpg)
� Goniotomy
� Trabeculotomy
� Trabeculectomy with Mitomycin C
� Glaucoma drainage devices (Molteno, Baerveldt, Ahmed)
� Cyclosdestructive procedures (CPK) – not CCK!!!
� Modified goniosurgery (removal of abnormal tissue
spanning between iris rudimentary stump and trabecular
meshwork)
� Trabectome in pseudophakia or simultaneous with phaco ???
Options of Glaucoma Surgery
Surgical Treatment Options in Aniridia
![Page 34: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/34.jpg)
Trabeculectomy with MMC
Surgical Treatment Options in Aniridia
![Page 35: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/35.jpg)
Corneal decompensation in up to 30% of eyesTopouzis et al. Am J Ophthalmol 1999
Glaucoma Drainage Devices
Surgical Treatment Options in Aniridia
![Page 36: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/36.jpg)
Major Treatment Problems
Iris Hypoplasia
Brunner SC, Walton DS, Chen TC: Aniridia. Int Ophthalmol Clinics 2008; 48 (2): 79-85
Surgical Treatment Options in Aniridia
![Page 37: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/37.jpg)
Surgical Treatment Options in Aniridia
Artificial Iris ?????
![Page 38: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/38.jpg)
Artificial Iris
Surgical Treatment Options in Aniridia
![Page 39: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/39.jpg)
� Eye lid surgery� Iris imitating contact lens � Corneal tattooing (Alio JL, et al. Br J Ophthalmol 2011; 95:1397-1401)
� Artificial iris into the capsular bag during cataract surgery
� We do NOT advocate implantation of artificial irides into the sulcus –� often worsening of glaucoma !!� risk of „progressive anterior fibrosis syndrome“
Options for Compensation of Iris Hypoplasia
Surgical Treatment Options in Aniridia
CAVE: PANAMA - „NewColorIris“
Tsai JH, Freeman JM, Chan CC et al: A progressive anterior fibrosis syndrome in patients with postsurgical congenital aniridia. Am J Ophthalmol 2005; 140:1075-1079
George MK, Tsai JC, Loewen NA: Bilateral irreversible severe vision loss from cosmetic iris implants. Am J Ophthalmol 2011; 151:872-875
![Page 40: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/40.jpg)
Simulation zur Implantation einer Iris-Teilprothese
Endergebnis desoperierten Auges
(Die Naht ist praktisch nicht sichtbar)
Gesundes Augemit intakter Iris
(Foto als Vorlage)
Verletztes Auge -partielle Aniridie
Fixierung derIris-Teilprothese
Surgical Treatment Options in Aniridia
Artificial Iris from Gore -Tex
Dr. Schmidt Intraocularlinsen GmbH
![Page 41: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/41.jpg)
Instead of Artificial Iris ……
Surgical Treatment Options in Aniridia
![Page 42: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/42.jpg)
Major Treatment Problems
Lens Abnormalities and Cataract - 50% - 85%
Surgical Treatment Options in Aniridia
Lee H, Khan R, O‘Keefe M: Aniridia: current pathology and management. Acta Ophthalmol 2008; 86:708-715
![Page 43: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/43.jpg)
� Fragile anterior lens capsule
� Zonular weakness
� Morphological changes at the equator
The Lens in Aniridia
Surgical Treatment Options in Aniridia
![Page 44: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/44.jpg)
HH26011999
Aufn v 08022011
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 45: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/45.jpg)
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 46: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/46.jpg)
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 47: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/47.jpg)
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 48: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/48.jpg)
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 49: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/49.jpg)
Surgical Treatment Options in Aniridia
The Lens in Aniridia
![Page 50: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/50.jpg)
Surgical Treatment Options in Aniridia
IOL Calculation
![Page 51: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/51.jpg)
IOL CalculationSurgical Treatment Options in Aniridia
Eye length
![Page 52: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/52.jpg)
Surgical Treatment Options in Aniridia
IOL Calculation
Corneal CurvatureCorneal Power
![Page 53: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/53.jpg)
- 90% as out-patient- Local anesthesia (RBA/PBA/Topical)- Clear cornea incision (2.5 mm)-Bimanual phacoemulsification- Foldable IOL implantation via inserter
Surgical Treatment Options in Aniridia
> 2000 Cataract Surgeries per Year in HOM
![Page 54: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/54.jpg)
PhacoemulsificationPhacoemulsification
Surgical Treatment Options in Aniridia
> 2000 Cataract Surgeries per Year in HOM
![Page 55: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/55.jpg)
Standard Cataract Surgery + Implantation of Artificial Lens
Microsurgeon: B. Seitz
Surgical Treatment Options in Aniridia
![Page 56: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/56.jpg)
� Black iris diaphragm IOL (Morcher 67F and 67G)
(sulcus fixated or sutured transsclerally)
(via 10 mm incision )
� Morcher aniridia ring type 50C:
designed for intracapsular insertion. Two of these rings
are implanted and turned against each other in order
to produce a full iris diaphragm
� Foldable blue-light-filtering IOL (via 2.5 to 3.0 mm incision)
Options of Lens Surgery
Surgical Treatment Options in Aniridia
![Page 57: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/57.jpg)
HI 13061962Aufn v 21112011
Surgical Treatment Options in Aniridia
Black Iris Diaphragm IOL
![Page 58: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/58.jpg)
Surgical Treatment Options in Aniridia
Black Iris Diaphragm IOL
![Page 59: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/59.jpg)
http://www.sciencedirect.com/science/article/pii/S0181551209000722#fig4
Surgical Treatment Options in Aniridia
Black Iris Diaphragm IOL
![Page 60: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/60.jpg)
Surgical Treatment Options in Aniridia
Iris Diaphragm IOL - Potential Complications
� Postoperative uveitis
� Seconday glaucoma
� Clinically significant macular edema
� Progression of corneal epithelial disorder
� Hyphaema
Reinhard T, Engelhardt S, Sundmacher R: Black diaphragm aniridia intraocular lens for congenital aniridia: Long-term follow-up. J Cataract Refract Surg 2000; 26:375-381
![Page 61: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/61.jpg)
http://www.sciencedirect.com/science/article/pii/S0181551209000722#fig4
Surgical Treatment Options in Aniridia
Coloured Iris Diaphragm IOL
![Page 62: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/62.jpg)
Surgical Treatment Options in Aniridia
Morcher Aniridia Ring Type 50C
![Page 63: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/63.jpg)
Surgical Treatment Options in Aniridia
Morcher Aniridia Ring Type 50C + Yellow IOL
![Page 64: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/64.jpg)
Surgical Treatment Options in Aniridia
![Page 65: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/65.jpg)
http://www.sciencedirect.com/science/article/pii/S0181551209000722#fig4
Surgical Treatment Options in Aniridia
Morcher Aniridia Ring Type 50C
![Page 66: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/66.jpg)
Major Treatment Problems
„Corneal Opacities“Anirida-Associated Keratopathy (AAK)
20% – 30%
Lee H, Khan R, O‘Keefe M: Aniridia: current pathology and management. Acta Ophthalmol 2008; 86:708-715
Surgical Treatment Options in Aniridia
![Page 67: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/67.jpg)
Anirida -Associated Keratopathy (AAK)
Surgical Treatment Options in Aniridia
![Page 68: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/68.jpg)
� Often starting in the first decade of life
� Limbal stem cell deficiency
� Conjunctivalization of the cornea
� Recurrent corneal erosions and ulcerations
� Often worse after surgery that involvesexcessive manipulation of the limbus – or
� after application of topical antimetabolites to treataniridia-associated glaucoma
Surgical Treatment Options in Aniridia
Anirida -Associated Keratopathy (AAK)
Edén U, Riise R, Tornqvist K: Corneal invcolvement in congenital anirida, Cornea 2010; 29:1096--1102
![Page 69: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/69.jpg)
� Dark glasses against photophobia
� Preservative-free lubricants
� Hyaluronic acid containing artificial tears
� 100% autologous serum eye drops
Surgical Treatment Options in Aniridia
Conservative Treatment of AAK
Jastaneiah S & Al-Rajhi AA: Association of aniridia and dry eyes. Ophthalmology2005; 112:1535—1540
Lopez-Garcia JS, Rivas L, Garcia-Lozano I, Murube J: Autologous serum eyedrops in the treatment of aniridic keratopathy. Ophthalmology 2008; 115:262-267
![Page 70: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/70.jpg)
Surgical Treatment Options in Aniridia
Anirida -Associated Keratopathy (AAK)
![Page 71: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/71.jpg)
Surgical Treatment Options in Aniridia
Anirida -Associated Keratopathy (AAK)
![Page 72: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/72.jpg)
Surgical Treatment Options in Aniridia
Anirida -Associated Keratopathy (AAK)
![Page 73: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/73.jpg)
� Amniotic membrane transplantation(incl. enhancing survival of limbal stem cells)
� Limbal stem cell transplantation
� Triplet matching of living related donor
� Non-matched organ-cultured donor� Keratolimbal allograft
� Ex vivo expansion of stem cells on amniotic membrane
Options of Corneal Surgery
Surgical Treatment Options in Aniridia
Systemic immunosuppression necessary !!!!
![Page 74: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/74.jpg)
� Penetrating excimer laser keratoplasty ?
� 14 mm deep lamellar corneoscleral graft
� 14 mm peripheral lamellar/central penetratingcorneoscleral graft
� Boston keratoprosthesis
Options of Corneal Surgery
Surgical Treatment Options in Aniridia
Rixen JJ et al: Treatment of aniridia with Boston Type I keratoprosthesis. Cornea 2013; Feb 26 [Epub ahead of print]
Kang JJ et al: Visual outcomes of Boston keratoprosthesis implantation as primary penetrating corneal procedure. Cornea 2012; 31:1436-1440
Bakhtiari P et al: Surgical and visual outcomes of the type I Boston keratoprosthesis for the management of aniridic fiibrosis sndrome in congenital anirida. Am J Ophthalmol 2012; 152:967-971
![Page 75: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/75.jpg)
Deutsches Keratoplastikregister Gemeldete Hornhauttransplantationen pro Jahr
1980 - 2011
Deutsches Keratoplastikregister gemeldete Hornhauttransplantationen pro Jahr
1980-2011
789 10
45
1145
1246
1203
1262
1407
1363
1470 16
92 1920
3367
3245
4148
2430
3375
3355
3025
2391 27
24
4730
4848
4735
4840
3673
3631 40
64 4380
4257
4030 45
33
0
1000
2000
3000
4000
5000
6000
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
~ 35.000 pro Jahr in den U.S.A. ↓↓↓↓~ 4.500 pro Jahr in Deutschland ↓↓↓↓
~ 250 pro Jahr in Homburg/Saar ↑↑↑↑
Sektion Kornea in der DOG
![Page 76: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/76.jpg)
Processed Corneas since Foundation of Processed Corneas since Foundation of LIONS Eye Bank in Homburg/SaarLIONS Eye Bank in Homburg/Saar
HornhautentnahmenUniversitäts-Augenklinik Homburg/Saar
154
260
185210
158 172
256
354
288
377 369
414
0
100
200
300
400
500
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Kalenderjahr
Anz
ahl H
ornh
aute
ntna
hmen
Surgical Treatment Options in Aniridia
Heute:Tag der Organspende !!!
![Page 77: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/77.jpg)
Corneal Transplantations in theCorneal Transplantations in theDepartment of Ophthalmology in Homburg/SaarDepartment of Ophthalmology in Homburg/Saar
KeratoplastikenUniversitäts-Augenklinik Homburg/Saar
13
8971
113
8071 64
52 57 62
9476
10490 85
94
65
105
171162
202208
243
0
40
80
120
160
200
240
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Kalenderjahr
Anz
ahl K
erat
opla
stik
en
Surgical Treatment Options in Aniridia
![Page 78: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/78.jpg)
Methode der Excimerlaser -Trepanation
Photoablation
durch die Maske geschütztesHornhautgewebe
Rotierender Laserstrahlgeführt über HeNe-Laser
Empfänger-maske
Rotierender Laserstrahlgeführt über HeNe-Laser
durch die Maske geschütztesHornhautgewebe
Photoablation
Spender-maske
Spender Empfänger
Surgical Treatment Options in Aniridia
![Page 79: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/79.jpg)
Spendermaske mit acht Erlanger/Homburger
„Orientierungszähnchen“
Empfängermaske mit acht „Orientierungskerben“
![Page 80: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/80.jpg)
Spender trepanation unmittelbar vor der
Perforation
Orientierungszähnchen
Behrens A, Seitz B, et al:"Orientation teeth" in nonmechanical laser corneal trephination for penetrating keratopasty: 2.94 µm Er:YAG vs. 193 nm ArF excimer laser.Br J Ophthalmol 1999; 83:1008-1012
![Page 81: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/81.jpg)
„Orientation Teeth “
Practical Advantage
for the Microsurgeon
Exact positioning of the second cardinal suture
Surgical Treatment Options in Aniridia
![Page 82: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/82.jpg)
Excimer Laser Trephination - VIDEO
Surgical Treatment Options in Aniridia
![Page 83: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/83.jpg)
Typical corneal grafts6 weeks after keratoplasty
![Page 84: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/84.jpg)
Markus Klingenstein 16121985
Aufn v 050122012
Surgical Treatment Options in Aniridia
Excimer Laser Keratoplasty with Single Sutures
![Page 85: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/85.jpg)
SF21031972
Foto 29092010
Surgical Treatment Options in Aniridia
Irreversible Graft Failure After Keratoplasty
![Page 86: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/86.jpg)
SF21031972
Foto 22112010
Surgical Treatment Options in Aniridia
Excimer Laser Keratoplasty with Single Sutures
![Page 87: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/87.jpg)
SF1031972
Foto 11052011
Surgical Treatment Options in Aniridia
Excimer Laser Keratoplasty with Single Sutures
![Page 88: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/88.jpg)
SF21031972
Foto 26102011
Surgical Treatment Options in Aniridia
Excimer Laser Keratoplasty with Single Sutures
![Page 89: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/89.jpg)
� Indispensable: Save the scleral spur !!
Spender
Surgical Treatment Options in Aniridia
Central 14 mm Corneoscleroplasty
![Page 90: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/90.jpg)
� Systemic Immunosuppression (Cyclosporin A oder MMF)
Central 14 mm Corneoscleroplasty
Surgical Treatment Options in Aniridia
![Page 91: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/91.jpg)
Boston Keratoprosthesis in Children
Surgical Treatment Options in Aniridia
![Page 92: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/92.jpg)
Boston Keratoprosthesis Visual results
patno diagnosisBCVAPreop
BCVAPostop
1 chem burn LP0.5�re OK�
0.15�LP
2 chem burn HM 0.9
3 chem burn LP 0.2
4 chem burn LP 1.2--> LP� OOKP
5 Limbal stem def eci FC 0.01
6 Limbal stem def eci LP LP
7 Limbal stem def eci FC FC
8 Aniridia LP 0.15
9 Aniridia LP 0.1
10 Aniridia FC 0.15
Lies Remeijer, SOE 2007
![Page 93: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/93.jpg)
Surgical Treatment Options in Aniridia
Boston Keratoprosthesis in Children
![Page 94: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/94.jpg)
�Anirida is a profibrotic disorder.�Therefore, many interventions - incl. penetrating keratopalsty and filtering surgery – tend to fail.�The Boston KPro may provide a more effective approach in the management of anirida-associated keratopathy AAK.�Guarded filtration surgery appears to be effctive in glaucoma.�Small incision cataract surgery seems to have advantages over large incisions for black iris diaphragm IOLs.
Summary
Surgical Treatment Options in Aniridia
![Page 95: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/95.jpg)
� Despite our increasing understandingof the genetics and pathophysiologyof congenital aniridia,
� effective treatment remains elusive
� with many of the conditions recurringafter surgical intervention.
�Strongly individualized approach -stay conservative
Conclusions
Surgical Treatment Options in Aniridia
![Page 96: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/96.jpg)
Erfahrung ist nicht vererbbar –
Jeder muß seine eigenen machen.
Kurt TucholskyJournalist und Schriftsteller
1890 - 1935
Surgical Treatment Options in Aniridia
![Page 97: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/97.jpg)
UniversitUniversitäätsklinikum des Saarlandes tsklinikum des Saarlandes UKSUKSKlinik fKlinik füür Augenheilkunde, Homburg/Saarr Augenheilkunde, Homburg/Saar
Direktor: Prof. Dr. med. Berthold Seitz, ML, FEBODirektor: Prof. Dr. med. Berthold Seitz, ML, FEBO
Unsere Augen – das Tor zur Welt
Surgical Treatment Options in Aniridia
![Page 98: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/98.jpg)
Ophthalmologist are Organ Donors!Ophthalmologist are Organ Donors!
Thank you very much for your attention !
![Page 99: Surgical Treatment Options in Congenital Aniridia · Surgical Treatment Options in Congenital Aniridia – Cataracts, Glaucomas, Corneal Opacities Berthold Seitz Universit ätsklinikum](https://reader030.vdocument.in/reader030/viewer/2022020306/5d27fd3788c993b7508d8d4b/html5/thumbnails/99.jpg)
Augen ärzte sind Organspender !Augen ärzte sind Organspender !
[email protected]@uks.eu
Vielen Dank für Ihre Aufmerksamkeit !Vielen Dank fVielen Dank f üür Ihre Aufmerksamkeit !r Ihre Aufmerksamkeit !