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Fine needle diathermy: a simple, safe and effective choice for occlusion of corneal vessels in patients with stromal vascularization before keratoplasty

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Session Details

Session Title: Presented Poster Session: Cornea I

Venue: Poster Village: Pod 3

First Author: : R.Falah SPAIN

Co Author(s): :    J. Armentia Perez De Mendiola   A. Matheu Fabra           

Abstract Details

Purpose:

To evaluated the efficacy and safety of fine needle diathermy (FND) occlusion of corneal vessels when used to reduce corneal vascularisation before keratoplasty and to reduce intraoperative bleeding. We report our experience with FND in 2 cases of scarring and vascularisation related to herpes simplex viral keratitis (HSVK) treated with FND in preparation for keratoplasty.

Setting:

Esperanza Hospital. Parc de Salut Mar: Department of ophthalmology: Two patients were referred to our department, males of 44 and 76 years old, both with corneal scarring and deep stromal neovascularization due consecutive episodes of HSVK. FND was preformed to occlude corneal vessels in both patients, as preparation to keratoplasty.

Methods:

FND was performed as Dr. Harminder Dua first described it in Nottingham in the year 2000. The procedure was done under topical anaesthesia. A circle side cutting, single-armed needle was inserted close to the limbus, parallel to and at approximately the same depth as the blood vessels to be occluded. The probe of a unipolar diathermy, in coagulating mode at its lowest setting, was brought into contact with the corneal needle, and contact was maintained until mild blanching of the corneal stroma occurred. Each vessel was treated individually.

Results:

In both our cases, the vessels were successfully occluded and further FND was not considered. 4 months later, patients remained stable with no recurrence of corneal vascularization. They both underwent successful corneal graft surgeries; a deep anterior lamellar keratoplasty (DALK) was performed in our younger patient and a penetrating keratoplasty in our older patient. At 1 year follow-up both grafts remained clear without a single sign of rejection.

Conclusions:

This is our initial experience with FND represented in only 2 cases, therefore definitive conclusions couldn’t be established. Nevertheless, based on our results and after reviewing the two largest series published since FND was described, we found this technique simple, inexpensive and effective in occluding established corneal vessels, the main recognized risk factor for corneal graft rejection and failure. The lack of any major intra and postoperative complications reinforces the safety profile of the procedure. FND can be repeated and performed in any small eye unit around the world, as it does not require specialized equipment.

Financial Disclosure:

NONE

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