Visante

Cycloplegia was induced using 1 drop of tropicamide HCI 1% (Minims, Bausch & Lomb, Kingston-Upon-Thames, UK). An objective measure of the refractive error and central corneal curvature was determined with a binocular open view autorefractor/keratometer (Shin-Nippon SRW-5000, Ryusyo Industrial Co. Ltd, Osaka, Japan). Five measurements were taken, averaged and converted to MSE (sphere power + 0.5 x cylinder power). AL and anterior chamber depth (ACD) measurements were taken with the commercially available IOLMaster (Carl Zeiss Meditec, Inc., Dublin, California, USA). Five separate measurements were averaged for AL, whereas three separate measurements were averaged for central corneal curvature (mm), and a single capture shot automatically generated and averaged five measurements of ACD. Corneal pachymetry measurements were obtained with the global pachymetry scan protocol on the AS-OCT (Visante; Carl Zeiss Meditec). The Visante system automatically processes 16 line scans and represents a map of the pachymetry values. The average reading for the central 2 mm was used for analysis.

For the donor cornea, the posterior side cut was set to be penetrating. A 0.2 mm undersized recipient cornea was trephined with similar settings, except that the depth of the posterior side cut was programmed to begin 70 μm anterior to the endothelium at the thinnest point on the optical coherence tomography pachymetry map (Visante, Carl Zeiss Meditec, Inc., Dublin, CA). In the operating room, the adhesions along the cut surface of the recipient cornea were dissected with a Sinskey hook (Rhein Medical, Tampa, FL), and the residual posterior stroma was cut with corneal scissors. The pupil was constricted with miotic (pilocarpine 1 %), and viscoelastic material was put into the anterior chamber to protect the lens. The donor button was then placed on the recipient and sutured with 16 interrupted 10–0 nylon sutures.
Tobramycin-dexamethasone ointment was applied to the eye at the end of the surgery. Eyes were patched and shielded. Postoperatively, patients were commenced on tobramycin- dexamethasone eyedrops with one drop 3 hourly, and slowly tapered over several months. Sutures were removed as clinically indicated.

All patients were examined and photographed using a slit-lamp biomicroscope (Haag-Streit BM900; Haag-Streit USA, Inc., Mason, Ohio) by experienced technicians at each visit. The lesion sites were analyzed by AS-OCT (Visante, Carl Zeiss Meditec, Inc., Dublin, CA). In addition, the central corneal thickness (CCT) and the corneal thickness at the site of the lesion (CTL) were also measured by AS-OCT. The same operator adjusted the software system to position the vertex at the center of the AS-OCT image. The thickness was measured using the software on the Visante AS-OCT. The CCT was measured with the caliper position at zero and recorded as the distance from the surface epithelium to the endothelium. CTL evaluation was performed manually at the site of the lesions. Cursors were placed perpendicular to the anterior corneal surface at the point of measurement.

All of the study participants were examined between January 2010 and August 2013 at the glaucoma and cataract service of Seoul National University Hospital, Seoul, Korea. All eligible participants were consecutively enrolled by retrospective medical-record review. At the initial clinic visit, all underwent a complete ophthalmic examination, including medical history review, best-corrected visual acuity measurement, slit-lamp biomicroscopy, Goldmann applanation tonometry (Haag-Streit, Koniz, Switzerland), funduscopic examination (90 diopter lens), stereoscopic optic disc photography, retinal nerve fiber layer photography, and gonioscopy, performed in the dark using a Sussman 4-mirror lens at high magnification (x16). Indentation gonioscopy with the same lens was used to establish the presence or absence of peripheral anterior synechiae. The cataract type and grade was evaluated, based on the Lens Opacity Classification System II [9 (link)]. Additionally, AS-OCT imaging (Visante, Carl Zeiss Meditec, Dublin, CA) and axial length (AL) measurement (IOL Master; Carl Zeiss Meditec) were performed at the initial or follow-up clinic visit.
This study, approved by the Seoul National University Hospital institutional review board adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all subjects.

Ocular examinations were performed at baseline, 1, 2, 3, 6 and 12 months after FCVB implantation. The arrangements of ocular examinations consist of VA with Snellen eye charts (transformed to logMAR) and IOP with Goldmann applanation tonometry (GAT; Haag-Streit AG, Köniz, Switzerlan), traditional slit lamp biomicroscopy (Nikon FS-2, Nikon Inc., Melville, NY), direct ophthalmoscopy, and fundus photography (TRC- 50EX; Topcon, Tokyo, Japan). A-scan ultrasound (CineScan A/B; Quantel Medical, Bozeman, MT), B-scan ultrasound (CineScan A/B; Quantel Medical, Bozeman, MT), noncontact specular microscopy (SP-3000P; Topcon, Tokyo, Japan), optical coherence tomography (OCT, Visante; Carl Zeiss Meditec, Dublin, CA), ultrasound biomicroscopy (UBM, SW-3200 Kinscan; Suoer, Tianjin, China) and were performed at baseline and 3 months after implantation.