101
|
Pluzsik MT, Tóth G, Tóth J, Matolcsy A, Langenbucher A, Kerényi Á, Nagy ZZ, Szentmáry N. Changing trends in penetrating keratoplasty indications at a tertiary eye care center in Budapest, Hungary between 2006 and 2017. Int J Ophthalmol 2020; 13:1814-1819. [PMID: 33215015 DOI: 10.18240/ijo.2020.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the changing trends in penetrating keratoplasty (PKP) indications. METHODS This retrospective study included all patients with PKP between 2006 and 2017. Patients were classified using histological diagnoses. Our groups were as the following: pseudophakic or aphakic bullous keratopathy, regraft, acute necrotizing and ulcerative keratitis, keratoconus, Fuchs' dystrophy, corneal dystrophy other than Fuchs', corneal scar, other diagnoses and failed endothelial keratoplasty graft. Additionally, two different time-periods (2006-2012 and 2013-2017) were analysed. RESULTS Totally 1721 histological analyses of 1214 patients were available for review. The diagnoses were pseudophakic or aphakic bullous keratopathy in 487 (28.3%), regraft in 443 (25.7%), acute necrotizing and ulcerative keratitis in 313 (18.2%), corneal scar in 153 (8.9%), keratoconus in 140 (8.1%). Fuchs' dystrophy in 61 (3.5%), corneal dystrophy other than Fuchs' in 46 (2.7%), other diagnoses in 44 (2.6%) and failed endothelial keratoplasty graft in 34 (2.0%) cases. From the first to the second analysed time-period, incidence of acute necrotizing and ulcerative keratitis, corneal scar, Fuchs' dystrophy increased (P≤0.032 for all) and incidence of keratoconus significantly decreased (P=0.015). CONCLUSION Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP, followed by regraft and acute necrotizing and ulcerative keratitis.
Collapse
Affiliation(s)
- Milán Tamás Pluzsik
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest 1106, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Jeannette Tóth
- 2nd Department of Pathology, Semmelweis University, Budapest 1091, Hungary
| | - András Matolcsy
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest 1085, Hungary
| | - Achim Langenbucher
- Experimental Ophthalmology, Saarland University, Homburg/Saar 66421, Germany
| | - Ágnes Kerényi
- Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest 1106, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University Homburg/Saar 66424, Germany
| |
Collapse
|
102
|
Cunha AM, Loja JT, Torrão L, Moreira R, Pinheiro D, Falcão-Reis F, Pinheiro-Costa J. A 10-Year Retrospective Clinical Analysis of Fungal Keratitis in a Portuguese Tertiary Centre. Clin Ophthalmol 2020; 14:3833-3839. [PMID: 33209016 PMCID: PMC7670085 DOI: 10.2147/opth.s268327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre. Methods A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted. Results Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687). Conclusion Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Dolores Pinheiro
- Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
103
|
Dohse N, Wibbelsman TD, Rapuano SB, Hammersmith KM, Nagra PK, Rapuano CJ, Syed ZA. Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty. Acta Ophthalmol 2020; 98:e895-e900. [PMID: 32190979 DOI: 10.1111/aos.14404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this study was to review the incidence, risk factors and outcomes of microbial keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). METHODS The electronic medical records at Wills Eye Hospital were queried for cases of microbial keratitis following PK or EK performed between 1 May 2007 and 1 September 2018. Charts were reviewed to obtain demographic data, transplant characteristics, details of microbial keratitis, graft survival and clinical outcomes. RESULTS During the study period, 2098 transplants were performed in 1601 patients. Of these, 1267 (60.4%) were PKs and 831 (39.6%) were EKs. We identified 86 (4.1%) cases of subsequent microbial keratitis. The incidence of microbial keratitis after PK was significantly higher than after EK (5.9% versus 1.3%; p = 0.005). Furthermore, the rate of infection was higher after repeat transplants (either PK or EK) compared to initial keratoplasties (5.5% versus 3.4%; p = 0.02). Twenty-six (32.1%) grafts remained clear at most recent follow-up after microbial keratitis, and the proportion of clear grafts was higher after EK than PK (66.7% versus 27.8%; p = 0.03). CONCLUSION Rates of microbial keratitis were significantly higher after PK compared to EK, and repeat transplantation was a risk factor for microbial keratitis. To the best of our knowledge, there is no prior study in the literature evaluating microbial keratitis rates after PK and EK and comparing outcomes.
Collapse
Affiliation(s)
- Nicolas Dohse
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Turner D. Wibbelsman
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Sara B. Rapuano
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Kristin M. Hammersmith
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Parveen K. Nagra
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Christopher J. Rapuano
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| | - Zeba A. Syed
- Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
- Cornea Service Wills Eye Hospital Philadelphia Pennsylvania USA
| |
Collapse
|
104
|
Said OM, Saleh MGA, Omar AF, Abdou AA, Riad Mostafa AN. Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty. Clin Ophthalmol 2020; 14:3495-3498. [PMID: 33149542 PMCID: PMC7602884 DOI: 10.2147/opth.s267888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty. Methods This study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination. Results The charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes). Conclusion Topical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.
Collapse
Affiliation(s)
- Omar M Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed G A Saleh
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Omar
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.,University Hospitals Eye Institute and the Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ahmed A Abdou
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | |
Collapse
|
105
|
Sheludchenko VM, Voronin GV, Osipyan GA, Djalili RA. [Methods of surgical treatment of keratectasia and analysis of postsurgical quality of vision]. Vestn Oftalmol 2020; 136:308-316. [PMID: 33063982 DOI: 10.17116/oftalma2020136052308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Keratectasias are non-inflammatory dystrophic diseases of the cornea characterized by progressive bilateral thinning of the cornea that lead to deterioration in the quantitative and qualitative characteristics of vision reducing patient's quality of life. The changes can be asymmetrical and destructive. A number of surgeries have been proposed to reduce the negative effects of keratectasia including penetrating keratoplasty and its modifications, implantation of corneal ring segments, corneal cross-linking - alone and in combination with other methods, intrastromal keratoplasty. These methods can improve visual acuity to a certain degree and help slow the progression of keratectasia. This article studies various surgical methods used for treating keratectasia and analyses possible assessment of the quality of vision before and after the treatment.
Collapse
Affiliation(s)
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Djalili
- Research Institute of Eye Diseases, Moscow, Russia
| |
Collapse
|
106
|
Alió Del Barrio JL, Bhogal M, Ang M, Ziaei M, Robbie S, Montesel A, Gore DM, Mehta JS, Alió JL. Corneal transplantation after failed grafts: Options and outcomes. Surv Ophthalmol 2020; 66:20-40. [PMID: 33065176 DOI: 10.1016/j.survophthal.2020.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Because of the large number of transplants, corneal graft failure has become one of the most common indications for corneal transplantation. The relatively recently developed lamellar transplant techniques have brought about specific potential complications leading to graft failure that may require different approaches to repeat transplantation other than penetrating keratoplasty. On the other hand, these new lamellar techniques also provide novel ways of rescuing failed penetrating grafts, with potential advantages over successive penetrating keratoplasties, such as reduced intraoperative risks and faster visual rehabilitation. We summarize the incidence and risk factors of graft failure for penetrating and lamellar (stromal and endothelial) corneal transplants and discuss the various surgical alternatives currently available to rescue such failed grafts, with a focus on the reported outcomes and limitations.
Collapse
Affiliation(s)
- Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| | | | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
| | - Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Scott Robbie
- Cornea Unit, Guy's & St Thomas' Hospital, London, UK
| | - Andrea Montesel
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Daniel M Gore
- External Disease Service, Moorfields Eye Hospital, London, UK
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
107
|
Abstract
The aim of this study was to investigate the histopathological manifestations of congenital corneal staphyloma accompanied by anterior segment dysgenesis and evaluate the prognosis after penetrating keratoplasty with an ultralarge button graft.We retrospectively studied 8 pediatric patients with large congenital corneal staphylomas in the Department of Ophthalmology of Peking University Third Hospital, China, between September 2014 and December 2018. All patients underwent penetrating keratoplasty with ultralarge button grafts, as well as additional operations according to the abnormality of each eye. Pathological investigations of all samples obtained during penetrating keratoplasty were performed with hematoxylin and eosin staining.The main clinical characteristic of congenital corneal staphyloma was an extremely opaque and ectatic cornea. Histopathological examination showed abnormal corneal epithelia and stroma and an absence of Bowman membrane, Descemet membrane, and the endothelium. Different severities of anterior segment dysgenesis, presenting as various histopathological manifestations, were observed in all cases. Several postoperative complications occurred after penetrating keratoplasty in some of the patients; however, the complications were discovered and treated accordingly in a timely manner. Six patients achieved good visual outcomes and a satisfactory cosmetic appearance after penetrating keratoplasty. One patient eventually lost the transparency of the button because of corneal neovascularization, and 1 patient lost visual function because of retinal detachment.Congenital corneal staphyloma combined with anterior segment dysgenesis can exhibit various manifestations on histopathological examination. Penetrating keratoplasty with an ultralarge button graft seems to be a suitable treatment for congenital corneal staphyloma to obtain good functional and aesthetic prognoses.
Collapse
|
108
|
Gujar P, Budhwani M. Combining keratoplasty with corneal tattooing. Indian J Ophthalmol 2020; 68:2220-2221. [PMID: 32971650 PMCID: PMC7727972 DOI: 10.4103/ijo.ijo_1234_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Prateek Gujar
- Department of Cornea, Sudarshan Netralaya, Plot No 61, Old MLA Quarters, Jawahar Chowk, Bhopal, Madhya Pradesh, India
| | - Monica Budhwani
- Department of Cornea, Sudarshan Netralaya, Plot No 61, Old MLA Quarters, Jawahar Chowk, Bhopal, Madhya Pradesh, India
| |
Collapse
|
109
|
Chen Y, Sun S, Gao M, Liu Q, Wang Z. Comparative observation of the efficacy of simplified Descemet stripping endothelial keratoplasty and penetrating keratoplasty in treating bullous keratopathy. Exp Ther Med 2020; 20:31. [PMID: 32952622 PMCID: PMC7480143 DOI: 10.3892/etm.2020.9158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to compare the clinical efficacy between simplified Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PKP) in the treatment of patients with bullous keratopathy (BK). A cohort of 65 patients (65 eyes) with BK recruited between December 2002 and June 2018 was divided into two groups according to the treatment they received: The simplified DSEK group (n=38) and the PKP group (n=27). The best-corrected visual acuity (BCVA) during the follow-up at 1, 3, 6 and 12 months and postoperative complications were all recorded. Furthermore, the graft survival rate after 1 year was recorded. The mean BCVA in the simplified DSEK group was significantly better than that in the PKP group after 1, 3, 6 and 12 months (P<0.05). Furthermore, the 1-year graft survival rate in the simplified DSEK group (91.2%) was significantly higher than that in the PKP group (70.4%; P=0.039). A total of 13 eyes (34.21%) in the simplified DSEK group and 11 eyes (40.74%) in the PKP group were diagnosed with glaucoma; there was no significant difference between the rate of glaucoma diagnosis between the two groups (P=0.591). Graft rejection was observed in 5 eyes (13.16%) of the simplified DSEK group and 8 eyes (29.63%) of the PKP group and the rate of graft rejection did not differ significantly between the groups (P=0.279). Graft infection occurred in 1 eye (2.63%) in the simplified DSEK group and 6 eyes (22.22%) in the PKP group. Simplified DSEK achieved better visual acuity and longer graft survival rates than PKP. The incidence of postoperative secondary glaucoma, graft rejection and graft infection after simplified DSEK was lower than that in the PKP group, but only the incidence of graft infection was significantly different.
Collapse
Affiliation(s)
- Yingxin Chen
- Department of Ophthalmology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, P.R. China
| | - Shanshan Sun
- Department of Ophthalmology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, P.R. China.,Department of Ophthalmology, The Third People's Hospital of Changzhou, Changzhou, Jiangsu 213001, P.R. China
| | - Minghong Gao
- Department of Ophthalmology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, P.R. China
| | - Qiming Liu
- Department of Ophthalmology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, P.R. China
| | - Ziyue Wang
- Department of Ophthalmology, The General Hospital of Northern Theater Command, Shenyang, Liaoning 110840, P.R. China
| |
Collapse
|
110
|
Özalp O, Atalay E, Köktaş Z, Yıldırım N. Distribution of Microbial Keratitis After Penetrating Keratoplasty According to Early and Late Postoperative Periods. Turk J Ophthalmol 2020; 50:206-210. [PMID: 32854461 PMCID: PMC7469893 DOI: 10.4274/tjo.galenos.2020.77026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The aim of this study was to investigate the distribution of microbial agents in the early and late postoperative periods in patients with microbial keratitis (MK) after penetrating keratoplasty (PK). Materials and Methods: The records of 36 patients who were clinically diagnosed as having MK after PK were retrospectively reviewed. Culture results were obtained from microbiology records and the organisms that were produced were noted. A case was deemed as viral keratitis based on the clinical appearance, negative cultures, and response to antiviral treatment. Keratitis development times were evaluated in 2 categories: early (within the first year) and late (after year 1) postoperative period. Mann-Whitney U and Kruskal-Wallis tests were used to compare numerical variables that did not show normal distribution and chi-square test was used to compare categorical variables. Results: The majority of MK cases were of bacterial origin (55.5%, n=20), followed by viral (41.7%, n=15) and fungal (2.8%, n=1). Of the 15 cases of early postoperative MK, 10 were bacterial, 4 were viral, and 1 was fungal; however, among cases of late postoperative MK, 10 were bacterial and 11 were viral. The majority (65%) of early and late bacterial infections were caused by gram-positive strains (most commonly staphylococci). Gram-positive bacteria caused keratitis significantly earlier than gram-negative bacteria (p=0.037). Viral and gram-negative bacterial MK was more frequent in the late postoperative period, but the difference was not statistically significant. Conclusion: In our study, bacterial keratitis was more common in post-keratoplasty MK than viral and fungal keratitis. Gram-positive bacteria were the most common causative agents. The increased incidence of gram-negative bacterial agents and viral keratitis in the late postoperative period can be explained by long-term topical steroid use.
Collapse
Affiliation(s)
- Onur Özalp
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| | - Eray Atalay
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| | - Zülfiye Köktaş
- Burdur Gölhisar State Hospital, Clinic of Ophthalmology, Burdur, Turkey
| | - Nilgün Yıldırım
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| |
Collapse
|
111
|
Chanbour W, Ayoub MH, Towair E, Darwish M, Fakhoury H, Warhekar P, Jarade E. Incidence, Risk Factors and Treatment Outcomes of Intraocular Hypertension and/or Glaucoma Post- Penetrating Keratoplasty: A 5-Year Lebanese Retrospective Descriptive Study. Clin Ophthalmol 2020; 14:2497-2505. [PMID: 32904671 PMCID: PMC7457568 DOI: 10.2147/opth.s263459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Glaucoma is one of the most common complications post-penetrating keratoplasty (PK). In this study, we report the Incidence, risk factors and treatment outcomes of intraocular hypertension (IOH) or/and glaucoma post-penetrating keratoplasty (PKG). Methods A 5-year descriptive retrospective study, Lebanese patients who underwent PK at Beirut Eye & ENT Specialist Hospital, between 2012 and 2017, were included. Patients with history of glaucoma were excluded. IOH/PKG cases that necessitate treatment were identified and analyzed for the incidence, risk factors and treatment outcomes. Results A total of 189 eyes of 159 patients were included, with male/female ratio 1.6 and the mean age 47.2±21.3 years. Bullous keratopathy (BK) presented with a high mean age: 70.3 years while ectasia patients were the youngest: 36.5 years. 34.9% of eyes developed high IOP within a mean of 25 months of follow-up distributed between sub-groups of patient with corneal ectasia (22.5%), redo-PK (51.2%), bullous keratopathy (BK) (50%), keratitis (24.9%), and others (dystrophy, trauma …) (21.4%). High IOP developed in 67.4% of the diabetic patients. Visual acuity was less likely to improve in cases developing elevated IOP while postoperative complications were significantly high. In those refractory to medical treatment, trabeculectomy as a glaucoma surgery was effective in lowering the IOP. Combining procedures with PK was not a risk factor for glaucoma. Interrupted sutures and higher number of suturing were associated with increased IOP levels. Conclusion IOH developed in one out of three patients who underwent penetrating keratoplasty. DM, bullous keratopathy, infectious keratitis and redo-PK were highly associated with PKG, whereas high IOP was less likely to develop in cases with keratoconus. Glaucoma is considered a poor prognostic factor in patients post-PK.
Collapse
Affiliation(s)
- Wassef Chanbour
- Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon.,Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Evelyne Towair
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mohamad Darwish
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Henry Fakhoury
- Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon.,Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elias Jarade
- Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon.,Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Mediclinic Dubai Mall, Dubai, United Arab Emirates
| |
Collapse
|
112
|
Abdelghany AA, D'Oria F, Alio JL. Surgery for glaucoma in modern corneal graft procedures. Surv Ophthalmol 2020; 66:276-289. [PMID: 32827497 DOI: 10.1016/j.survophthal.2020.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
Glaucoma is a common cause of vision loss after corneal transplantion and is considered a major risk factor for graft failure. Glaucoma may be present before corneal transplant surgery, or increased intraocular pressure may develop after keratoplasty in up to one-third of patients. Pre-existing glaucoma should be controlled before keratoplasty, either medically or surgically. For postkeratoplasty increase in intraocular pressure; identifying the risk factors allows appropiate follow-up and management. Patients undergoing anterior lamellar keratoplasty may take advantage of reduced rates of postkeratoplasty glaucoma. Glaucoma also complicates eyes with endothelial keratoplasties, mostly related to management of intraocular pressure spikes derived from anterior chamber air bubbles. Nevertheless, the severity is less, and the intraocular pressure is more easily controlled when compared with penetrating keratoplasty. Adequate management of glaucoma that develops before or after keratoplasty may save eyes from irreversible damage to the optic nerve and increase graft survival.
Collapse
Affiliation(s)
- Ahmed A Abdelghany
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Faculty of Medicine, Ophthalmology Department, Minia University, Minia, Egypt
| | - Francesco D'Oria
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alio
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| |
Collapse
|
113
|
Liu H, Zhang XR, Xu HC, Ma Y, Huang LY, Zhai LY, Zhao Y. Effects of VEGF Inhibitor Conbercept on Corneal Neovascularization Following Penetrating Keratoplasty in Rabbit Model. Clin Ophthalmol 2020; 14:2185-2193. [PMID: 32801629 PMCID: PMC7410491 DOI: 10.2147/opth.s260302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To evaluate the effects of the vascular endothelial growth factor inhibitor conbercept (KH902) on corneal neovascularization and wound healing following penetrating keratoplasty in rabbits. Methods Conbercept was administered to New Zealand white rabbits through topical and subconjunctival routes. Corneal neovascularization and wound healing were examined by slit-lamp photography and histological analyses. The expressions of vascular endothelial growth factor inhibitor, α-smooth muscle actin, and keratocan in the corneal grafts were measured by real-time quantitative polymerase chain reaction (RT-qPCR). Results The anterior segment photographs demonstrated that corneal neovascularization started in the 2nd week. In the 4th week, histologically, the superficial corneal stroma layer showed disordered arrangement, and there were large numbers of dense inflammatory cells and blood vessels in the stroma layer. Vascular endothelial growth factor in the experimental groups was significantly decreased at all time points compared with the control group (both P = 0.001). Expression of α-smooth muscle actin in corneal grafts demonstrated an increase in time even it was lower in experimental groups, but the difference was not statistically significant (P equaled to 0.507 and 0.723, respectively). There were no significant differences with the expression of keratocan in all groups except that it significantly declined at the 4th week as to the second week in all groups and P values were 0.022, 0.020 and 0.014 in control (C), topical (E1), and subconjunctival (E2) group, respectively. Conclusion The study found that conbercept inhibited the formation of corneal neovascularization without affecting keratocan-mediated corneal wound healing and there were no significant differences between topical administration of different doses of conbercept on the rabbit corneal neovascularization after penetrating keratoplasty in this study.
Collapse
Affiliation(s)
- Huan Liu
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei OPO Eye Bank, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Xiao-Rong Zhang
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Hebei OPO Eye Bank, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Hong-Chang Xu
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yue Ma
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Li-Ying Huang
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Li-Ying Zhai
- Division of Ocular Injuries, Department of Ophthalmology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ying Zhao
- Hebei OPO Eye Bank, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| |
Collapse
|
114
|
Ikpoh BI, Kunselman A, Stetter C, Chen M. Lost to follow-up: reasons and characteristics of patients undergoing corneal transplantation at Tenwek Hospital in Kenya, East Africa. Pan Afr Med J 2020; 36:95. [PMID: 32774654 PMCID: PMC7392857 DOI: 10.11604/pamj.2020.36.95.19993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/01/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction corneal transplantation is a surgical procedure requiring consistent long-term follow-up to maximize the chance of graft survival. The purpose of this study was to explore patient characteristics and reasons for being lost to follow-up (LTFU). Methods a retrospective review of clinical records from January 2012 to October 2014 was conducted of patients who received corneal transplantation at Tenwek Hospital. At the time of chart review, all patients who provided a mobile phone number were contacted to answer a phone questionnaire. Logistic regression was used to assess the association of each patient characteristic, separately, with the outcome of LTFU. Results of the 118 patients that met inclusion criteria, 40 (33.9%) were considered LTFU by failing to follow up at Tenwek Hospital to at least one year postoperatively. The odds of LTFU for patients age 60 and older were 3.78 times that of those who were 18-59 (95% CI: 1.21-11.80]; p-value=0.02). The odds of LTFU for patients with a preoperative diagnosis of pseudophakic bullous keratopathy were 3.83 times that of those with a preoperative diagnosis of keratoconus (95% CI: [1.13-12.94]; p-value=0.03). Education level, employment status, distance from the hospital, and possession of a mobile contact number appeared marginally associated with follow-up status, though not statistically significant at the 0.05 significance level. Financial barriers were the most commonly cited reason for LTFU (42.4%, n=14). Conclusion certain reasons and patient characteristics may be associated with follow-up adherence. Identifying these factors may help providers identify patients who are at a higher risk of LTFU and influence providers in medical decision-making and system-based interventions when offering corneal transplantation.
Collapse
Affiliation(s)
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Christy Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Michael Chen
- Penn State College of Medicine, Hershey, Pennsylvania, United States of America.,Tenwek Hospital, Bomet, Bomet County, Kenya.,Penn State Eye Center, Hershey, Pennsylvania, United States of America
| |
Collapse
|
115
|
Yang K, Zhao Y, Lu H, Zang Y, Mao Y, Hong J, Jie Y. Graft survival and endothelial outcomes after penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty: A systematic review and meta-analysis. Exp Ther Med 2020; 20:2794-2804. [PMID: 32765774 PMCID: PMC7401902 DOI: 10.3892/etm.2020.9010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/29/2020] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to compare the outcomes of graft survival, endothelial cell loss and vision improvement between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for treating corneal endothelium diseases. The PubMed, CENTRAL (Cochrane) and Embase databases were searched for records added until September 20, 2019. The studies considered were two-arm prospective and retrospective studies comparing outcomes of interest between PK and DSAEK. Ultimately, 10 studies were included with a total of 2,634 patients (910 eyes treated with DSAEK; 1,804 eyes treated with PK). Assessment of the summary effect by meta-analysis suggested that, compared with PK treatment, DSAEK was associated with a greater improvement from baseline in best spectacle-corrected visual acuity [difference (diff.) in means of change from baseline=-0.225, 95% CI=-0.341 to -0.109, P<0.001] and a reduced loss of endothelial cell density (diff. in means=-292.05 cells/mm2, 95% CI=-419.53 to -146.57 cells/mm2, P<0.001). Graft survival rates were similar using either PK or DSAEK (odds ratio=1.005, 95% CI=0.329-3.071, P=0.993). The overall results suggested that DSAEK may have an advantage over PK for corneal endothelial dysfunction in terms of the visual acuity outcome. The absence of definite time frames in the comparisons limits the conclusions on endothelial cell loss and graft survival.
Collapse
Affiliation(s)
- Ke Yang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| | - Yang Zhao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| | - Hongshuang Lu
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| | - Yunxiao Zang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| | - Yu Mao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| | - Jiaxu Hong
- Department of Ophthalmology, Eye & Ent Hospital, School of Shanghai Medicine, Fudan University, Shanghai 200031, P.R. China
| | - Ying Jie
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China
| |
Collapse
|
116
|
Busool Abu Eta Y, Tomkins-Netzer O, Mimouni M, Hamed Azzam S, Shehadeh Mashour R. Predicting factors of ocular hypertension following keratoplasty: Indications versus the procedure. Eur J Ophthalmol 2020; 31:1749-1753. [PMID: 32762247 DOI: 10.1177/1120672120948757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the incidence of ocular hypertension (OHTN) following penetrating keratoplasty (PKP) versus deep anterior lamellar keratoplasty (DALK) corneal transplant surgeries, and to assess the impact of indication for transplantation versus surgery type on OHTN development. METHODS A retrospective study of 76 eyes of 76 patients who underwent PKP or DALK between 1 January 2009 and 1 September 2014. Data included: preoperative intraocular pressure (IOP), indication and type of surgery, post-surgical IOP at 1 to 5, 14 to 21 days, 3, 6 months, 1 year and at the last follow up. Primary outcome was post-operative OHTN (defined as IOP >21 mm Hg). RESULTS A total of 13 patients (17.1%) developed OHTN of whom 9 (20.45%) underwent PKP and 4 (12.5%) DALK (p = 0.33). OHTN occurred after an average of 16.46 ± 8.47 months (0.1-58 months). Twenty-one keratoconus patients (39.62%) underwent PKP and 32 (60.37%) underwent DALK. Patients with indications other than keratoconus all underwent PKP. Keratoconus patients were less likely to develop OHTN (9.43% vs 34.78%, p = 0.02). Among patients developing OHTN, mean age of the non-keratoconus group was significantly higher (63.25±16.7 vs 33 ± 10, p = 0.01). No significant difference in OHTN among keratoconus patients undergoing DALK versus PKP (12.5% vs 4.76%, respectively, p = 0.35) was found. PKP was associated with less OHTN in keratoconus eyes (4.76% vs 34.78%, p = 0.02). CONCLUSION Patients who underwent keratoplasty due to keratoconus are at a lower risk to develop OHTN than those who underwent surgery for other indications.
Collapse
Affiliation(s)
- Yumna Busool Abu Eta
- Department of Ophthalmology, University Hospitals of Leicester, Leicester, UK.,Department of Ophthalmology, Saint Vincent de Paul Hospital, Nazareth, Affiliated to the Faculty of Medicine, Bar Ilan university, Israel
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Micheal Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Shireen Hamed Azzam
- Department of Ophthalmology, the Baruch Padeh Medical Center, Poriya, Israel
| | | |
Collapse
|
117
|
Bischoff-Jung M, Flockerzi E, Hasenfus A, Viestenz A, Matoula P, Schlötzer-Schrehardt U, Seitz B. Recurrence of macular corneal dystrophy on the graft 50 years after penetrating keratoplasty. GMS Ophthalmol Cases 2020; 10:Doc34. [PMID: 32884888 PMCID: PMC7452946 DOI: 10.3205/oc000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose: To report the recurrence of a macular corneal stromal dystrophy 50 years after penetrating keratoplasty (PKP). Methods: Observational case report Casedescription: A 76-year-old male patient presented with visual impairment in the right eye (OD) 50 years after PKP in 1962 (44 years after PKP also in the left eye (OS) in 1968) following explosion injury. His visual acuity had already been impaired before the trauma because of bilateral corneal opacities. The central corneal thickness of the graft measured 584 µm (OD) and 544 µm (OS), whilst the peripheral host thickness (8 mm zone), however, was 1233 µm (OD, cranial) and 1131 µm (OS, nasal). The original graft diameter measured 6 mm in both eyes and the recipient cornea was cloudy and gray. The endothelial cell count was measured centrally (OD 1162 c/mm2, OS 1320 c/mm2). The visual acuity was 20/100 (OD) and 20/40 (OS). After excimerlaser-assisted repeated PKP (8.0/8.1 mm, OD), the histological analysis of the former graft revealed deposits of acid mucopolysaccharides (AMP) subepithelially, within the interface, in the donor stroma, and in the endothelium, which proved the peripheral recurrence of a macular corneal stromal dystrophy on the graft. Conclusion: Recurrence of macular corneal stromal dystrophy is seldom, but it may occur many decades after PKP. In this patient, the host’s stroma was twice as thick as that of the graft. This may be caused by the active production of acid mucopolysaccharides in the host endothelium with secondary endothelial decompensation. Thus, PKP remains the gold standard in the cure of macular corneal dystrophy for long-term visual rehabilitation.
Collapse
Affiliation(s)
- Mona Bischoff-Jung
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Andrea Hasenfus
- Institute of Pathology, Saarland University Medical Center, Homburg, Germany
| | - Arne Viestenz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Pinio Matoula
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | | | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
118
|
Abstract
This case study reports the successful deployment of the XEN45 gel stent (AbbVie Inc, Chicago, IL) through an ab externo approach in a 73-year-old woman with refractory glaucoma following high-risk penetrating keratoplasty (PK) 10 years prior. The PK was for corneal perforation secondary to peripheral ulcerative keratitis, which required systemic immunosuppression comprising intravenous cyclophosphamide, azathioprine, and corticosteroids to stabilise the disease and prevent corneal graft rejection. The patient’s intraocular pressure was reduced from 40 mmHg preoperatively to 12 mmHg six months after surgery, off medication. The patient’s visual acuity and visual fields remained stable. The XEN45 gel stent utilising the ab externo approach can be considered as a potential tool to lower intraocular pressure in patients with glaucoma after corneal keratoplasty.
Collapse
Affiliation(s)
- Lanxing Fu
- Department of Cornea, Manchester Royal Eye Hospital, Manchester, GBR
| | - Michelle L Baker
- Department of Glaucoma, Manchester Royal Eye Hospital, Manchester, GBR
| | - Fiona Carley
- Department of Cornea, Manchester Royal Eye Hospital, Manchester, GBR
| | - Leon Au
- Department of Glaucoma, Manchester Royal Eye Hospital, Manchester, GBR
| |
Collapse
|
119
|
Gomez-Elizondo DE, Lopez-Martinez M, Ruiz-Lozano RE, Valdez-Garcia JE, Hernandez-Camarena JC. Corneal perforation associated with isolated ocular lichen planus: a case report. Eur J Ophthalmol 2020; 31:NP9-NP12. [PMID: 32493062 DOI: 10.1177/1120672120932089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To report a case of unilateral corneal perforation due to isolated ocular lichen planus. METHODS Interventional case report. Informed consent by the patient was obtained to publish clinical images. A 64-year-old male presented with severe vision loss and a 2-week history of corneal perforation treated with penetrating keratoplasty in the left eye. He had a longstanding diagnosis of severe chronic dry eye disease. On the initial assessment a visual acuity of 20/50 in the RE and HM perception in the left eye were documented. Biomicroscopy revealed subepithelial fibrosis on the tarsal conjunctiva and clinical signs of severe dry eye disease in both eyes. A clear corneal button and a white cataract were observed in the left eye. No other skin or mucosal lesions were observed. RESULTS An excisional biopsy of the bulbar conjunctiva was performed under topical anesthesia. Direct immunofluorescence analysis revealed a linear deposit of fibrinogen in the basement membrane consistent with ocular lichen planus. Clinical improvement was achieved using aggressive topical lubrication, corneal epithelial regenerators, topical tacrolimus, and immunosuppressive therapy with systemic corticosteroids and cyclophosphamide. CONCLUSION Isolated ocular lichen planus is an extremely infrequent presentation of lichen planus often indistinguishable from other cicatricial conjunctivitis. Corneal perforation is a severe complication associated with severe dry eye, not previously reported with ocular lichen planus. An adequate clinical assessment and histopathologic diagnosis are crucial to lead prompt treatment and prevent sight-threatening complications.
Collapse
Affiliation(s)
| | | | | | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | |
Collapse
|
120
|
Gogri P, Bhombal FA. A new technique for fitting of tricurve rigid gas-permeable contact lens in penetrating keratoplasty eyes using Scheimpflug imaging. Indian J Ophthalmol 2020; 68:1057-1060. [PMID: 32461429 PMCID: PMC7508130 DOI: 10.4103/ijo.ijo_936_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Rigid gas-permeable (RGP) contact lens fitting after penetrating keratoplasty (PK) is challenging due to significant irregular astigmatism. The aim of the study was to determine a guideline for selecting the initial base curve (BC) of the RGP contact lens fitting in post PK eyes. Methods: The data of patients who had tricurve RGP contact lens fitting post PK were collected retrospectively. The following data were collected: best-corrected visual acuity with glasses and contact lenses; contact lens parameters which included the BC and diameter; corneal topography parameters which included steep keratometry value (K), flat-K, and mean-K; and anterior best fit sphere (BFS) measured using Scheimpflug imaging. Results: The median age of the 40 subjects (46 eyes) who met the inclusion criteria was 37.5 years (IQR 26.7–45.5). The spherical equivalent was –3.00 diopter (D) (–8.31 to –1.56). The median steep-K, flat-K, and mean-K in them were 6.76 mm (6.28–7.07), 7.78 mm (7.37–8.14), and 7.26 mm (6.93–7.46), respectively. The median anterior BFS value of the transplanted cornea was 6.96 mm (6.6–7.37). The median BC of the final RGP lens was 7.0 mm (6.7–7.23) and the median diameter was 9.8 mm (9.4–10.4). Among all the Scheimpflug imaging parameters, the BFS correlated well with the final BC of the RGP contact lens dispensed (R 0.742, P < 0.0001). Conclusion: The anterior corneal surface BFS value can be used as a reference in selecting the initial BC of tricurve RGP contact lens to achieve the best fitting and reducing the chair time of patients after PK.
Collapse
Affiliation(s)
- Pratik Gogri
- Tej Kohli Cornea Institute, Bausch and Lomb Contact Lens Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Faiza A Bhombal
- Tej Kohli Cornea Institute, Bausch and Lomb Contact Lens Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
121
|
Kumar M, Shetty R, Lalgudi VG, Vincent SJ. Scleral lens wear following penetrating keratoplasty: changes in corneal curvature and optics. Ophthalmic Physiol Opt 2020; 40:502-509. [PMID: 32436631 DOI: 10.1111/opo.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Visual rehabilitation following penetrating keratoplasty is the primary indication for approximately 15% of all scleral lens fittings. Since corneal biomechanics are altered following penetrating keratoplasty, the aim of this study was to quantify changes in anterior corneal optics following short-term scleral lens wear in eyes with corneal grafts. METHODS Scheimpflug images were obtained before and after a period of scleral lens wear (mean 6.3 ± 1.4 h), from eyes that had previously undergone penetrating keratoplasty (10 eyes of nine participants, mean age 31 ± 9 years). Corneal power and thickness data were examined over the central 6 mm, including regional analyses of the central (0-3 mm) and the mid-peripheral cornea (3-6 mm annulus) using customised software to deterime corneal power vectors M (best fit sphere), J0 (90/180 astigmatism) and J45 (45/135 astigmatism). Anterior corneal aberrations were extracted using corneal elevation data. RESULTS Corneal power vector J45 increased following lens wear (by 0.22 ± 0.05 D, p = 0.003) across the central 6 mm, while M displayed regional variations following lens wear indicating larger changes further from the corneal centre (p = 0.004). The change in corneal power vector M was also correlated with the magnitude of central corneal swelling (r = 0.65, p = 0.04). The anterior corneal aberration terms of oblique astigmatism, hoirzontal coma, and spherical aberration also varied following lens wear (all p ≤ 0.01). The mean change in the corneal spherocylinder derived from the elevation data following lens wear was +0.14/-0.54 × 44 for a 6 mm corneal diameter. CONCLUSIONS Clinically significant alterations in anterior corneal topography and higher order aberrations were observed following short-term scleral lens wear in eyes that had undergone penetrating keratoplasty. Spherocylindrical changes were approximately double the magnitude and more oblique in orientation compared to previous reports of healthy eyes. Changes in corneal power vector M may be related to epithelial corneal oedema.
Collapse
Affiliation(s)
- Mukesh Kumar
- Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Narayana Nethralaya, Bangalore, Karnataka, India
| | | | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry & Vision Science, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
122
|
Bamashmus MA, Al-Shekeil MA, Mukred FA, Al-Akhlee HA. Traumatic wound dehiscence after penetrating keratoplasty: Clinical features and outcome in 53 cases in Yemen. Taiwan J Ophthalmol 2020; 10:32-36. [PMID: 32309122 PMCID: PMC7158935 DOI: 10.4103/tjo.tjo_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/24/2019] [Indexed: 11/16/2022] Open
Abstract
AIMS: Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management and outcome of surgery for traumatic wound dehiscence occurring in patients who had PKP. SUBJECTS AND METHODS: This retrospective study included post-PKP patients who sustained traumatic wound dehiscence at the Cornea Unit in Yemen Magrabi Eye Hospital between 2008 and 2016. Fifty-three eyes with a history of wound dehiscence were treated with primary wound closure. Patient files were reviewed for type and time of injury, distance visual acuity (VA), and outcome. RESULTS: Ruptured globe with dehiscence of wound occurred on average 2.4 years (3 months to 13 years) after PKP. The mean age at wound dehiscence was 22.27 years and males accounted for 77.4% (41). All patients were managed with primary closure of the wound. Lensectomy of traumatic or dislocated lens was the most frequent additional surgical procedure (14, 26.4%), followed by anterior vitrectomy (6, 11.3%). In the end, 43 (81.1%) grafts remained clear. In the last follow-up, 34 eyes (64.1%) had best-corrected VA of 20/200 or better and two eyes had no perception of light. CONCLUSION: Rupture globe and wound dehiscence occurs after PKP at the graft–host junction. Wound dehiscence is a lifelong risk after PKP and wound weakness persisted for a long period after PKP. Visual outcome and graft survival are generally poor after the injury, and the restoration of a satisfactory visual result is possible if treated early.
Collapse
Affiliation(s)
- Mahfouth Abdalla Bamashmus
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Cornea Unit, Magrabi Eye Hospital, Sana'a, Yemen
| | | | | | | |
Collapse
|
123
|
Ozer MD, Altinkurt E, Alparslan N. The long-term surgical outcomes of conjunctival-limbal autograft procedure with or without penetrating keratoplasty in eyes with unilateral limbal stem cell deficiency. Taiwan J Ophthalmol 2020; 10:22-28. [PMID: 32309120 PMCID: PMC7158933 DOI: 10.4103/tjo.tjo_55_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/21/2019] [Indexed: 12/15/2022] Open
Abstract
AIM: The aim of the study is to report the results of conjunctival-limbal autograft (CLAU) transplantation and penetrating keratoplasty (PK) in eyes with limbal stem cell deficiency (LSCD) due to chemical or thermal injury. METHODS: Thirty-one eyes of the 31 patients, who had unilateral LSCD due to chemical or thermal injury, were included in the study. Bilaterally affected cases and LSCD due to Steven-Johnson syndrome and mucous membrane pemphigoid were excluded from the study. All patients underwent a complete ophthalmologic examination. The surgical procedures, postoperative complications, ocular surface status, and visual outcomes were noted. RESULTS: In the CLAU group, regular corneal epithelium and ambulatory vision (≤1.0 logarithm of the minimum angle of resolution [20/200]) were achieved in 81% of eyes, including 22 eyes (71%) that were assessed after a mean follow-up period of 58 months, respectively. The 5-year survival rate of corneal allograft was 33%, 4 ± 13.9 in the CLAU applied eyes. In addition, the corneal graft clarity maintenance rate was found to be higher in patients having ≥12 months duration between CLAU and PK, which is statistically significant (62% vs. 23%, P = 0.046). CONCLUSION: Waiting at least 1 year after CLAU transplantation to perform PK increases corneal clarity. Eyelid problems, even if the eyelids were reconstructed properly, remain a major risk factor for the development of the epithelial disorder in the early and late postoperative period in CLAU applied eyes.
Collapse
Affiliation(s)
- Muhammet Derda Ozer
- Department of Ophthalmology, Medical Faculty, Van Yuzuncu Yil University, Tuşba, Van 65080, Turkey
| | - Emre Altinkurt
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34000, Turkey
| | - Nilufer Alparslan
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34000, Turkey
| |
Collapse
|
124
|
Sun XT, Zhai HL, Cheng J, Kong QQ, Cong L, Li L, Hao WP. Indications for penetrating keratoplasty and anterior lamellar keratoplasty during 2010-2017. Int J Ophthalmol 2019; 12:1878-1884. [PMID: 31850172 DOI: 10.18240/ijo.2019.12.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To review the indications of penetrating keratoplasty (PK) and anterior lamellar keratoplasty (ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS A total of 1869 eyes were included, among which 1405 eyes (75.2%) had PK and 464 eyes (24.8%) had ALK. The leading indications were suppurative keratitis (36.8%), keratoconus (15.5%), herpes keratitis (13.1%), and regraft (10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis (38.7%), herpes keratitis (15.3%), keratoconus (12.6%), and regraft (12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis (30.8%), keratoconus (24.1%), corneal dystrophies and degenerations (10.6%), and corneal dermoid tumor (9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.
Collapse
Affiliation(s)
- Xiao-Tong Sun
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Hua-Lei Zhai
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Jun Cheng
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Qian-Qian Kong
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Lin Cong
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Lin Li
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| | - Wen-Pei Hao
- Qingdao Eye Hospital of Shandong First Medical University, Shandong Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao 266071, Shandong Province, China
| |
Collapse
|
125
|
Rickmann A, Boden KE, Wahl S, Jung S, Boden KT, Szurman P, Januschowski K. Significant differences between specular microscopy and corneal bank endothelial cell counts - a pilot study. Acta Ophthalmol 2019; 97:e1077-e1081. [PMID: 31282615 DOI: 10.1111/aos.14185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/11/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND It was shown recently that endothelial cell count performed by cornea banks overestimates the real number of endothelial cells. The aim of this study was to investigate the internal quality of preclinical ECD in human donor corneas using two widely used methods for endothelial cell counting, transmitted light microscopy used in organ culture tissue bank and clinically used specular microscopy. METHODS Twenty human donor corneas that could not be transplanted were included in this analysis. Differences in evaluating endothelial cell density (ECD) and hexagonal endothelial cell ratio (HEX) between clinical specular microscopy (CSM) and corneal bank transmitted light microscope (CBLM) were evaluated as well as differences between automated and manual cell counts. RESULTS Automated CBLM showed a higher ECD of 31.85% compared to automated CSM, while manual CBLM counting is 10.51% higher compared to manual CSM (p < 0.01). Further, higher average ECD values result in a higher difference between CSM and CBLM measurements. The manual CBLM ECDs were significantly higher compared to automated derived ECD from CSM (p < 0.01). However, no systematic bias can be detected when comparing the differences of the measurements with the average ECD measurements of both methods. CONCLUSION This preclinical pilot study confirmed a significant higher ECD using transmitted light microscopy in organ culture compared to clinical specular microscopy. This indicates that the early rapid decrease of EC universally observed after surgery might be partly artefactual.
Collapse
Affiliation(s)
| | - Katrin E. Boden
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
| | - Silke Wahl
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
| | | | - Karl T. Boden
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
| | - Peter Szurman
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
- Centre for Ophthalmology University Eye Hospital Tübingen Tuebingen Germany
| | - Kai Januschowski
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
- Centre for Ophthalmology University Eye Hospital Tübingen Tuebingen Germany
| |
Collapse
|
126
|
Khairy HA, Elsawy MF, Said-Ahmed K, Zaki MA, Mandour SS. Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial. Int J Ophthalmol 2019; 12:1714-1719. [PMID: 31741859 DOI: 10.18240/ijo.2019.11.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the clinical outcomes of the standard corneal cross linking (CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty. METHODS Totally 120 eyes of 83 patients scheduled to receive either standard CXL (3 mW/cm2 for a period of 30min) or accelerated CXL (18 mW/cm2 for a period of 5min). The main outcomes for comparison were the change in: maximum-K reading (K-max), manifest refractive spherical equivalent (SE), central corneal thickness (CCT), and the best corrected distance visual acuity (CDVA). RESULTS One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group. CONCLUSION Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.
Collapse
Affiliation(s)
- Hany A Khairy
- Department of Ophthalmology, Menoufia University Hospitals, Menoufia 35211, Egypt
| | - Moataz F Elsawy
- Department of Ophthalmology, Menoufia University Hospitals, Menoufia 35211, Egypt
| | - Khaled Said-Ahmed
- Department of Ophthalmology, Menoufia University Hospitals, Menoufia 35211, Egypt
| | - Marwa A Zaki
- Department of Ophthalmology, Menoufia University Hospitals, Menoufia 35211, Egypt
| | - Sameh S Mandour
- Department of Ophthalmology, Menoufia University Hospitals, Menoufia 35211, Egypt
| |
Collapse
|
127
|
Watson SL, Cabrera-Aguas M, Keay L, Khoo P, McCall D, Lahra MM. The clinical and microbiological features and outcomes of fungal keratitis over 9 years in Sydney, Australia. Mycoses 2019; 63:43-51. [PMID: 31556179 DOI: 10.1111/myc.13009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 11/27/2022]
Abstract
To describe the clinical features, management and outcomes in patients with fungal keratitis at the Sydney Eye Hospital, Australia, over a 9-year period to guide appropriate initial therapy. A retrospective case review was conducted. Patients diagnosed with fungal keratitis from 1 January 2009 to 31 December 2017 were identified from hospital coding and pathology databases. Data were extracted from the medical records. A total of 55 episodes from 51 patients were included. Mean age was 60 ± 20 years (range: 19-91 years), and 33 were male. The fungal species was not identified in two patients. Predisposing factors included ocular surface disease in 17 eyes (32%); corneal disease, 15 (28%); corneal trauma, 12 (23%); and contact lens wear, 13 (24.5%). Fusarium spp. (15, 27%) and Candida parapsilosis (10, 18%) were the most common isolates. The median visual acuity at presentation was 1.3 logMAR (range: 0 to 3) and after treatment 0.7 logMAR (range: -0.02 to 3) (P = .008). Despite medical therapy, most commonly with natamycin and topical and oral voriconazole, surgical intervention was required in 21 eyes (40%); including antifungal injections in 9 (16%); corneal transplantation, 16 (30%); evisceration, 2 (4%); and enucleation, 1 (2%). A poor visual outcome was recorded in 27 of 43 (63%) patients. Fungal keratitis remains a cause of significant ocular morbidity; the majority of patients face a poor outcome despite intense medical and at times surgical treatment. In our setting, fungal keratitis was more commonly associated with corneal or ocular surface disease.
Collapse
Affiliation(s)
- Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Maria Cabrera-Aguas
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Lisa Keay
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,School of Optometry, University of New South Wales, Sydney, NSW, Australia
| | - Pauline Khoo
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | | | - Monica M Lahra
- New South Wales Health Pathology Microbiology, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
128
|
Mayalı H, Kayıkçıoğlu Ö, Altınışık M, Bıçak F, Kurt E. Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis. Turk J Ophthalmol 2019; 49:270-276. [PMID: 31650801 PMCID: PMC6823587 DOI: 10.4274/tjo.galenos.2019.87059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK). Materials and Methods From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143). Conclusion Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.
Collapse
Affiliation(s)
- Hüseyin Mayalı
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Özcan Kayıkçıoğlu
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Muhammed Altınışık
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Faruk Bıçak
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Emin Kurt
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| |
Collapse
|
129
|
Arenas E, Mieth A. Lamellar sclerokeratoplasty: Review of the literature and description of a special technique using fibrin glue and a giant hydrophilic contact lens. Taiwan J Ophthalmol 2019; 9:160-165. [PMID: 31572652 PMCID: PMC6759550 DOI: 10.4103/tjo.tjo_54_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/12/2019] [Indexed: 11/17/2022] Open
Abstract
Lamellar sclerokeratoplasty is a surgical procedure described since 1979 by Lim in China and reported by different surgeons in the world. Our purpose is to report a modified technique in which not only the whole cornea with a scleral rim is utilized, but the importance of including the whole Schlemm's canal area is also insisted; therefore, a new aqueous humor drainage pathway can be restored. The technique is designed for cases in which not only the whole cornea is decompensated, but also have untreatable glaucoma. This procedure replaces the entire anterior segment with a clear donor cornea including the limbus and part of the trabecular meshwork. We present the results of visual acuity by the logMAR scale of 55 cases from 110 patients receiving this surgical technique. The results describe 39 cases that had visual improvement after more than 1 year of follow-up and 16 cases that did not improve in their visual acuity. Large-diameter sclerokeratoplasty is an alternative and therapeutic option to eliminate the entire corneal pathology, while obtaining structural and even optical results with a lower immunological reaction. It can be considered an option in cases that are not suitable for standard grafting procedures.
Collapse
Affiliation(s)
- Eduardo Arenas
- Profesor, El Bosque University and National University, Bogota, Colombia
| | | |
Collapse
|
130
|
D’Oria F, Galeone A, Pastore V, Cardascia N, Alessio G. Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e17140. [PMID: 31517855 PMCID: PMC6750735 DOI: 10.1097/md.0000000000017140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature. PATIENT CONCERNS A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus. DIAGNOSES Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface. INTERVENTIONS Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days. OUTCOMES During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively. LESSONS Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.
Collapse
|
131
|
Nishino T, Kobayashi A, Yokogawa H, Mori N, Sugiyama K. Changing indications and surgical techniques for keratoplasty during a 16-year period (2003-2018) at a tertiary referral hospital in Japan. Clin Ophthalmol 2019; 13:1499-1509. [PMID: 31496641 PMCID: PMC6689759 DOI: 10.2147/opth.s214515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To present the changing indications and surgical techniques for keratoplasty during a 16-year period (2003–2018) at a tertiary referral hospital in Japan. Methods Consecutive keratoplasty cases at Kanazawa University Hospital from January 2003 to December 2018 were retrospectively reviewed. Keratoplasty procedures included penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), anterior lamellar keratoplasty (ALK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), and Descemet’s membrane endothelial keratoplasty (DMEK). Annual numbers and types of keratoplasty as well as underlying diseases for PK and total keratoplasty procedures were recorded, and annual trends were statistically analyzed using Cochran–Armitage test for trend. Results A total of 801 keratoplasty procedures (PK, 319 cases; DALK, 57 cases; ALK, 9 cases; DSAEK, 371 cases; and DMEK 45 cases; mean age, 66.9±16.3 years) were performed for 595 patients (302 males [329 eyes, 419 cases], 293 females [345 eyes, 382 cases]) during the 16-year period. The proportion of PK procedures decreased significantly in the beginning and showed a slightly increasing trend after a plateau around 2015. DSAEK was increasing after 2006 and reached a plateau around 2012. Among 10 underlying diseases for total keratoplasty, corneal opacity and dermoid were decreasing linearly. Failed PK and failed DSAEK were increasing linearly in the beginning and reached a plateau followed by a decreasing trend. In terms of the underlying disease for PK, bullous keratopathy was decreasing in the beginning and reached a plateau around 2015. A total of 19 PK procedures were performed on cases with recalcitrant bullous kerstopathy (BK) after 2010. Conclusion The distribution of keratoplasty procedures and underlying diseases changed significantly over 16 years at a tertiary referral hospital in Japan. PK procedure was significantly decreased and DSAEK procedure was significantly increased. PK for BK decreased significantly; however, PK remains a viable option for other recalcitrant corneal diseases.
Collapse
Affiliation(s)
- Tsubasa Nishino
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Akira Kobayashi
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hideaki Yokogawa
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Natsuko Mori
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| |
Collapse
|
132
|
Merridew NL, Phagura RS, Anderson E, Cooley LA, Pollock GA, McEwan B, McCartney PJ, Trad MA. Successful Treatment of Mycobacterium chelonae Keratitis Within a Corneal Transplant Using Intrastromal Amikacin Injections-A Case Report Demonstrating the Fundamental Principles and Challenges of Infective Keratitis Management and Novel Therapeutic Approaches. Open Forum Infect Dis 2019; 6:ofz340. [PMID: 31660386 PMCID: PMC6735860 DOI: 10.1093/ofid/ofz340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Mycobacterium chelonae keratitis is rare and difficult to treat. This is the first known case worldwide of effective treatment using intrastromal amikacin injections in a corneal transplant recipient who had metastatic breast cancer. The challenges and principles of management, applicable to other causes of infective keratitis, are reviewed.
Collapse
Affiliation(s)
- Nancy Louisa Merridew
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Australia
| | | | - Edward Anderson
- Department of Pharmacy, Royal Hobart Hospital, Hobart, Australia
| | - Louise Anne Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Australia
| | - Graeme Alfred Pollock
- Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia
| | - Belinda McEwan
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Australia
| | | | - Mohamad-Ali Trad
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Australia
| |
Collapse
|
133
|
Chen NN, Wu PL, Chen HC, Huang TY, Lai LJ. Prevalence of microbial contamination in donor corneas. Taiwan J Ophthalmol 2019; 9:179-184. [PMID: 31572655 PMCID: PMC6759555 DOI: 10.4103/tjo.tjo_60_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE: Postoperative infection is the most disastrous complication of penetrating keratoplasty (PK). Corneoscleral rim culture provided information regarding subsequent infections. Our aims were to identify the incidence of microbial contamination in donor corneas and to report the recovery of bacteria with two culture methods, i.e., conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (Fastidious Antibiotic Neutralization [FAN]). MATERIALS AND METHODS: A total of 118 patients underwent PK. Corneoscleral rim cultures were performed using aerobic/anaerobic culture cotton swabs (Transystem™, COPAN, Italia) with subsequent convention media and blood culture media (FAN bottle, BD BACTEC™, USA). The results of the different methods were reported and analyzed. RESULTS: Microorganisms were recovered from 24 in total 118 cases (20.3%, n = 118), 14 from blood culture media (FAN) (11.8%, n = 118), 9 from conventional culture media after aerobic/anaerobic cotton swabs (7.63%, n = 118), and 2 from fungus culture (1.69%, n = 118). The most commonly identified pathogen was coagulase-negative Staphylococcus (CoNS) (n = 13, 54.2%), and more isolates of CoNS and staphylococcus aureus were recovered from blood culture media (FAN) than those from conventional culture media after aerobic/anaerobic cotton swabs (13 vs. 4, P = 0.05). Conversely, more nonfermentative Gram-negative bacilli were recovered from conventional culture media after aerobic/anaerobic cotton swabs. None of the 24 cases with positive corneoscleral rim cultures reported ocular infection for the recipients in at least 6 months’ follow-up. CONCLUSION: The conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (FAN) did not yield identical isolates of bacteria. The blood culture media (FAN) could further yield Gram-positive bacteria in addition to those recovered from convention media. It seemed adding gentamicin and streptomycin could achieve bacteriostatic effect instead of the bactericidal effect. The administration of postoperative antibiotic in the recipient was suggested.
Collapse
Affiliation(s)
- Nan-Ni Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hung-Chi Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Yu Huang
- Department of Infection, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Ju Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
134
|
Abstract
Keratectasia (KE) ranks as one of the main causes of impaired vision. The pathology is characterized by progressive thinning of the cornea, which causes its deformation, the appearance of irregular astigmatism, and the reduction of vision acuity. The article reviews modern surgical methods that can be used to prevent the progression and treat various types of KE.
Collapse
Affiliation(s)
- G A Osipyan
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - V M Sheludchenko
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - Kh Khraystin
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| |
Collapse
|
135
|
Krysik K, Lyssek-Boron A, Janiszewska-Bil D, Wylegala E, Dobrowolski D. Impact of ultrasound and optical biometry on refractive outcomes of cataract surgery after penetrating keratoplasty in keratoconus. Int J Ophthalmol 2019; 12:949-953. [PMID: 31236351 DOI: 10.18240/ijo.2019.06.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/13/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To analyse the impact of ultrasound and optical intraocular lens (IOL) calculation methods on refractive outcomes of cataract phacoemulsification performed after penetrating keratoplasty (PK) in keratoconus. METHODS Phacoemulsification cataract surgery was performed on 42 eyes of 34 patients with keratoconus who had previously undergone PK. The IOL power was determined by using both standard and corneal topography-derived keratometry using the SRK/T formula. We used two independent methods-ultrasound biometry (UB) and interferometry [optical biometry (OB)] for IOL calculation. The analysed data from medical records included demographics, medical history, best corrected visual acuity (BCVA) on Snellen charts, technique of IOL calculation and calculation formula and its impact on final refractive result. RESULTS BCVA ranged from 0.01 to 0.4 (mean 0.09±0.19) before surgery and ranged from 0.2 to 0.7 (mean 0.38±0.14) at 1mo and from 0.2 to 1.0 (mean 0.56±0.16) (P<0.05) at 3mo, postoperatively. The refractive aim differed significantly from the refractive outcome in both the UB and OB groups (P<0.05). There was no statistically significant difference in the accuracy of the two biometry methods. CONCLUSION The refractive aim in keratoconus eyes post-PK is not achieved with either ultrasound or OB.
Collapse
Affiliation(s)
- Katarzyna Krysik
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Centre, Sosnowiec 41-200, Poland
| | - Anita Lyssek-Boron
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Centre, Sosnowiec 41-200, Poland
| | - Dominika Janiszewska-Bil
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Centre, Sosnowiec 41-200, Poland.,Department of Ophthalmology, District Railway Hospital, Katowice 40-760, Poland
| | - Edward Wylegala
- Department of Ophthalmology, District Railway Hospital, Katowice 40-760, Poland.,Chair and Clinical Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Katowice 40-760, Poland.,Hebei Provincial Eye Hospital, Xingtai 054001, Hebei Province, China
| | - Dariusz Dobrowolski
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Centre, Sosnowiec 41-200, Poland.,Department of Ophthalmology, District Railway Hospital, Katowice 40-760, Poland.,Chair and Clinical Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Katowice 40-760, Poland
| |
Collapse
|
136
|
Fujita A, Yoshida J, Toyono T, Usui T, Miyai T. Severity Assessment of Acute Hydrops Due to Recurrent Keratoconus after Penetrating Keratoplasty Using Anterior Segment Optical Coherence Tomography. Curr Eye Res 2019; 44:1189-1194. [PMID: 31172834 DOI: 10.1080/02713683.2019.1629597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the clinical characteristics of acute hydrops between eyes with recurrent keratoconus and eyes with treatment-naïve keratoconus.Methods: Six eyes with acute hydrops caused by recurrent keratoconus (recurrent group) and 29 eyes with acute hydrops due to treatment-naïve keratoconus (naïve group) were included. We collected data from anterior-segment optical coherence tomography (AS-OCT), corneal topography and medical records. With AS-OCT, we investigated the location of Descemet's membrane break, the length and frequency of Descemet's membrane detachment, and the speed of corneal thinning before acute hydrops.Results: Descemet's membrane breaks were detectable in 6 cases in the recurrent group (100%) and 7 cases in the naïve group (70%). Distance from the break to the central line was 2-3 mm in the recurrent group, and less than 1 mm in the naïve group (p < .001). Detachment length was significantly greater in the recurrent group than in the naïve group (p = .003). Steep corneal power values tended to increase before acute hydrops in the recurrent group, but the difference between groups was not significant (observation period; 6.03 ± 2.67, 7.36 ± 5.53 years, respectively). Penetrating keratoplasty was required in 5 cases (83%) in the recurrent group, and 8 cases (28%) in the naïve group (p = .02).Conclusions: Acute hydrops due to recurrent keratoconus occurred around graft-host junctions and was more severe than that in eyes with treatment-naïve keratoconus. Severity assessment of Descemet's membrane detachment using AS-OCT provided clues not only for diagnosis, but also for predicting prognosis.
Collapse
Affiliation(s)
- Asahi Fujita
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Junko Yoshida
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuya Toyono
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomohiko Usui
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan.,Department of Ophthalmology, The International University of Health and Welfare, Narita-shi, Chiba-ken, Japan
| | - Takashi Miyai
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
137
|
Abstract
There are no standardized protocols or guidelines for the treatment of recurrent fungal keratitis after therapeutic keratoplasty. This study aimed to investigate the incidence of recurrent fungal keratitis after the primary keratoplasty and the visual outcome and prognosis after intervention for the recurrence.This was a retrospective study. Patients with recurrent fungal keratitis after lamellar keratoplasty (LK) or penetrating keratoplasty (PK) were treated with different antifungal regimens at Shandong Eye Hospital and Qingdao Eye Hospital between Januray 2004 and December 2015. The operative techniques included PK, focal excision, tectonic keratoplasty with a patch graft, lensectomy and vitrectomy, and combined operation. Patients were followed at 1, 2, and 3 months, and then every 6 months after surgery for 2 years. Best corrected visual acuity was assessed and recurrence was recorded. Good prognosis was defined as the presence of visual acuity.Fungal keratitis recurred in 112 of 1448 patients (112/1448, 7.7%) treated initially with PK or LK. The good prognosis rates for different sites of recurrent fungal keratitis were: overall, 93 of 112 (83.0%); recipient bed, 64 of 69 (92.8%); anterior chamber, 14 of 14 (100%); posterior segment, 10 of 16 (62.5%); and atypical, 5 of 13 (38.5%). There was no significant difference in the timing of recurrence between the good and poor prognosis groups (P = .518). Recurrence rates were similar between patients with PK (8.6%) and those with LK (6.0%; P > .05), but the good prognosis rate in patients with post-LK recurrence (96.8%) was higher than that in patients with post-PK recurrence (77.8%, P = .017).Individualized treatment according to recurrent sites of fungal keratitis can achieve a good prognosis in most patients.
Collapse
Affiliation(s)
- Yuerong Gong
- Shandong University, Jinan
- Department of Ophthalmology, Binzhou Medical University Hospital, Binzhou
| | - Meng Xin
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| |
Collapse
|
138
|
Sitaula S, Singh SK. Corneal deposition of fluoroquinolones after penetrating keratoplasty: case series. Int Med Case Rep J 2019; 12:151-154. [PMID: 31191042 PMCID: PMC6512573 DOI: 10.2147/imcrj.s198011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administration post-penetrating keratoplasty. Case reports: Herein we report three patients ranging in age from 42-65 years who underwent keratoplasty with cataract extraction, with intraocular lens implantation in the first two cases and left aphakic due to a posterior capsular tear in the third case. The first two patients received ciprofloxacin-dexamethasone combination drops, and developed drug deposition, which was observed at the first follow-up after 7 and 10 days respectively. The third patient received prednisolone acetate and ofloxacin eyedrops postoperatively, and developed drug deposits in the cornea after 20 days. In all of the three patients, the fluroquinolone group of drugs was discontinued and the cornea cleared gradually over the next 3-4 weeks. Although the cornea cleared, the first two grafts failed due to recurrent viral infection in one case, and graft rejection in the other case. Conclusion: Deposition of many different fluroquinolones in the cornea has been reported after a variety of surgeries, including penetrating keratoplasty. Drug deposition post-penetrating keratoplasty may seem innocuous due to self-resolution on cessation of the drugs, but it may have deleterious effects on graft survival. Hence, fluroquinolones, especially ciprofloxacin, should be cautiously used in patients undergoing penetrating keratoplasty if frequent dosing is prescribed or if used concurrently with other topical medications containing preservatives.
Collapse
Affiliation(s)
- Sanjeeta Sitaula
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute Of Medicine, Kathmandu, Nepal
| | - Sanjay K Singh
- Department of Cornea Clinic, Biratnagar Eye Hospital, Biratnagar, Nepal
| |
Collapse
|
139
|
Al-Sharif E, AlEnezi SH, Sharif HA, Osman EA. Ocular bleeding in an undiagnosed hemophiliac neonate causing irreversible loss of vision: A case report with review of the literature. Eur J Ophthalmol 2019; 30:NP62-NP65. [PMID: 30938185 DOI: 10.1177/1120672119841188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Suprachoroidal hemorrhage is an unexpected complication after penetrating keratoplasty during childhood. We report the case of delayed suprachoroidal hemorrhage after penetrating keratoplasty in a neonate as the first manifestation of hemophilia. CASE REPORT A 4-day-old neonate was referred to our hospital because of bilateral corneal opacities present since birth. A diagnosis of bilateral Peter's anomaly type 2 with right eye corneal perforation was made after examination. Appropriate treatment was commenced, and later, right eye therapeutic penetrating keratoplasty combined with lensectomy, and anterior vitrectomy was performed. This was complicated postoperatively with suprachoroidal hemorrhage and retinal detachment. Conservative management was advised due to poor visual prognosis. Three months later, the patient was found to have high intraocular pressure in the left eye and glaucoma surgery was recommended. Proper hematological investigations before glaucoma surgery in the left eye revealed a low level of factor VIII with normal levels of factor IX and von Willebrand's factor antigen. Therefore, a diagnosis of hemophilia type A was established. CONCLUSION This case serves as a reminder that the occurrence of suprachoroidal hemorrhage, especially in the absence of other predisposing risk factors, should warrant detailed systemic assessment to exclude underlying bleeding disorders.
Collapse
Affiliation(s)
- Eman Al-Sharif
- Department of Ophthalmology, King Abdul-Aziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad H AlEnezi
- Department of Ophthalmology, Majmaah University, Al Majmaah, Saudi Arabia
| | - Heba Al Sharif
- Department of Ophthalmology, King Abdul-Aziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Essam A Osman
- Department of Ophthalmology, King Abdul-Aziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
140
|
Abstract
Objectives: To evaluate the outcomes of penetrating keratoplasty performed for therapeutic and tectonic purposes in eyes with perforated infectious corneal ulcer. Materials and Methods: This retrospective study included 43 eyes of 43 patients who developed perforated infectious corneal ulcer of various etiological causes between June 2008 and January 2018. The patients were evaluated based on age and sex, follow-up time, presence of corneal perforation, pre- and postoperative visual acuity, postoperative graft transparency, complications, and infection recurrence. Results: The mean age of the 43 patients was 52.9±13.8 years. The mean follow-up time was 2.7±1.3 years. Preoperatively, the visual acuity of the eyes was at the level of hand motions or counting fingers; postoperative best corrected visual acuity ranged from hand motions to 0.7. Postoperative complications included hyphema in 8 patients (18.6%), elevated intraocular pressure in 14 (32.5%), posterior synechiae in 18 (41.8%), and cataract in 22 patients (51%). Therapeutic and tectonic success was achieved in 42 patients (97.6%). Postoperative graft transparency was observed in 35 patients (83.3%) within the 1-year follow-up period and in 27 patients (71.0%) at 2 years. Among 27 patients with graft transparency, 23 had bacterial and 4 had viral etiologies (p=0.52); 16 patients had perforations smaller than 1 mm and 11 had perforations 1-3 mm in size (p=0.2). Conclusion: Therapeutic-tectonic keratoplasty for perforated infectious corneal ulcer successfully restored globe integrity in 97.6% of cases. The rate of graft transparency was 71.0% at 2 years, with no effect of etiological agent or perforation size.
Collapse
Affiliation(s)
- Cezmi Doğan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Osman Şevki Arslan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| |
Collapse
|
141
|
Barraquer RI, Pareja-Aricò L, Gómez-Benlloch A, Michael R. Risk factors for graft failure after penetrating keratoplasty. Medicine (Baltimore) 2019; 98:e15274. [PMID: 31027083 PMCID: PMC6831321 DOI: 10.1097/md.0000000000015274] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022] Open
Abstract
The objective of our study was to define principal risk factors for graft failure in patients who underwent penetrating keratoplasty (PK).Retrospective data obtained from a cohort of 895 penetrating keratoplasties performed between 2001 and 2006 were analysed. Recipient related factors, graft characteristics, and surgical technique were assessed in a univariate analysis and with a multivariate proportional hazard model to detect principal risk factors for definitive graft failure.Multivariate analysis showed clear significance for diagnosis and number of previous grafts and border line significance for the oldest donor age group. Patients with keratoconus had the best 10-year survival estimate (95%), followed by endothelial and stromal dystrophies (both 55%), infectious leukomas (49%), trauma (33%) and chemical burns (14%). Primary PK grafts had a survival rate of 81%, second grafts of 33% and third or more grafts of 16%. Overall 10-year survival estimate based on univariate analysis was found to be 65%.In conclusion, we found that primary diagnosis and previous graft failures in the recipient are the most important risk factors of graft failure after a PK.
Collapse
Affiliation(s)
- Rafael Ignacio Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
- Universitat Internacional de Catalunya, Barcelona
| | - Luis Pareja-Aricò
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Hospital Clinico Universitario Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Alba Gómez-Benlloch
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
| | - Ralph Michael
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
| |
Collapse
|
142
|
Dubey S, Jain K, Mukherjee S, Sharma N, Pegu J, Gandhi M, Bhoot M. Current profile of secondary glaucoma in a Northern India tertiary eye care hospital. Ophthalmic Epidemiol 2019; 26:200-207. [PMID: 30714467 DOI: 10.1080/09286586.2019.1574840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To study the current profile of secondary glaucoma in all age groups of patients presenting to a tertiary eye care hospital in Northern India Materials and methods: In this retrospective study, files of 5725 patients who were newly diagnosed to have glaucoma in our tertiary eye care centre from January 2014 to December 2016 were reviewed. Detailed data were collected from patient's records, including history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy findings, gonioscopy, and fundus findings. Demographic data, aetiology, and management in all these patients were also noted. RESULTS Out of 5820 patients who visited glaucoma outpatient department (OPD) in a tertiary eye care hospital during 1 January 2014 to 31 December 2016, 5725 patients were diagnosed to have glaucoma by the glaucoma specialists. Five thousand three hundred and six patients (92.68%) were diagnosed to have primary glaucoma and 419 patients (7.32%) were diagnosed to have secondary glaucoma. The leading causes of secondary glaucoma were found to be neovascular glaucoma (17.42%), trauma (14.80%), post-keratoplasty (13.60%), post-cataract surgery (13.13%), and lens-induced glaucoma (12.41%). Secondary glaucoma was found to be an important cause of visual morbidity with 71.17% eyes presenting with BCVA < 6/60, IOP > 30 mm Hg in 62% eyes and 72% with cup-to-disc ratio of ≥0.7:1. CONCLUSION Secondary glaucoma is an important cause of visual morbidity. Timely diagnosis and prompt management are essential to prevent irreversible visual loss due to secondary glaucoma.
Collapse
Affiliation(s)
- Suneeta Dubey
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Kanika Jain
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Saptarishi Mukherjee
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Neha Sharma
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Julie Pegu
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Monica Gandhi
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| | - Madhu Bhoot
- a Glaucoma Services , Dr. Shroff's Charity Eye Hospital , Daryaganj , New Delhi , India
| |
Collapse
|
143
|
Gao M, Chen Y, Wang J, Wang C. Post-operative outcomes associated with Boston type 1 keratoprosthesis implantation in Northeast China. Exp Ther Med 2019; 17:869-873. [PMID: 30651874 DOI: 10.3892/etm.2018.6994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022] Open
Abstract
The aim of the present study was to investigate the post-operative outcomes associated with Boston type 1 keratoprosthesis (Kpro-1) implantation in the treatment of patients with corneal blindness in Northeast China. Clinical data of patients who had undergone Kpro-1 implantation between July 2010 and November 2014 were retrospectively collected. The visual performance, implant retention and post-surgical complications were recorded for each patient. A total of 20 patients (20 eyes) with corneal blindness were included in the study. Prior to surgery, the patients exhibited poor vision and decreased levels of light perception. At 3 days, 1 month, 6 months, 1 year and 2 years post-surgery, logarithm of the minimum angle of resolution values were significantly decreased compared with the pre-operative values. The initial Kpro-1 implants were retained in 16 eyes. Regarding the post-operative complications, six patients exhibited retroprosthetic membrane formation, two patients presented with endophthalmitis, two patients developed secondary glaucoma, two patients experienced optical cylinder detachment, two patients presented with corneal melting, three patients had retinal detachment, three patients developed corneal ulcers and one patient had secondary optic neuropathy. Overall, the results of the present study suggested that implantation with Kpro-1 may represent an alternative therapeutic strategy for patients following previously failed keratoplasty in Northeast China. Serious complications associated with Kpro-1 implantation are common, and thus, suitable patient selection, continuous follow-up and early treatment interventions are recommended.
Collapse
Affiliation(s)
- Minghong Gao
- Department of Ophthalmology, The General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110840, P.R. China
| | - Yingxin Chen
- Department of Ophthalmology, The General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110840, P.R. China
| | - Jing Wang
- Department of Ophthalmology, The General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110840, P.R. China
| | - Cuiyu Wang
- Department of Ophthalmology, The General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110840, P.R. China
| |
Collapse
|
144
|
Roca M, García A, Peñas-Pardo L, Bosch-Aparicio N, Agustí J. Sphingomonas paucimobilis keratitis in a patient with neurotrophic keratopathy and severe neurosensory hypoacusis: Treatment with penetrating keratoplasty and amniotic membrane grafting. Oman J Ophthalmol 2018; 11:291-293. [PMID: 30505128 PMCID: PMC6219320 DOI: 10.4103/ojo.ojo_98_2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a man with neurotrophic keratitis of unknown ethiology, who developed a massive stromal melting during treatment of a persistent epithelial defect. A tectonic keratoplasty combined with amniotic membrane grafting was made. Host cornea specimen was analyzed, and Sphingomonas paucimobilis was isolated.
Collapse
Affiliation(s)
- Manuel Roca
- Department of Ophthalmology, Hospital Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| | - Arantxa García
- Department of Ophthalmology, Hospital Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| | - Lucas Peñas-Pardo
- Department of Anatomic pathology, Hospital Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| | - Nuria Bosch-Aparicio
- Department of Anatomic pathology, Hospital Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| | - Jaime Agustí
- Department of Anatomic pathology, Hospital Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| |
Collapse
|
145
|
Abstract
Corneal transplantation is the most successful and frequently performed allotransplantation procedure. Benign outcome of penetrating and posterior keratoplasty depends on viability of the corneal tissue and presence of the proper endothelial layer, which retaining is one of the main objectives of preservation of donor material. Methods designed to reach this goal may be classified according to storage duration as short-term (storage in a moist chamber), medium-term (hypothermia), long-term (organ cultivation) and unlimited (cryopreservation). While there are reports of successful application of cryo-conserved corneas for penetrating keratoplasty, its use for this type of transplantation is limited due to complexity of the method and very high requirements for the quality of donor material. However, being a method of unlimited storage, it still attracts the attention of researchers. Taking into account the ongoing development of innovative keratoplasty technologies and the tendency for predominant use of layered grafts that in some cases do not need viable endothelium, methods of preservation of such material for anterior lamellar and intralamellar keratoplasties become relevant. In this context, cryopreservation without the use of cryoprotective agents is promising because it allows simple and fast accumulation of large amount of material with long storage time. Further research on the development of preservation methods of the corneal endothelial layer at sub-zero temperatures may allow storing the material by cryopreservation that will be suitable for penetrating and posterior keratoplasty.
Collapse
Affiliation(s)
- G V Voronin
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow Medical University, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - G A Osipyan
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - S V Trufanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E A Budnikova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V N Rozinova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A M Subbot
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M A Makarova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| |
Collapse
|
146
|
Gediz F, Yüksel B, Küsbeci T, Akmaz O, Kartı Ö. The Effect of Donor- and Recipient-Related Factors on Corneal Graft Survival in Penetrating Keratoplasty. Semin Ophthalmol 2018; 34:11-18. [PMID: 30496015 DOI: 10.1080/08820538.2018.1549681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate the impact of donor and recipient factors on graft survival in penetrating keratoplasty (PK).Material and Methods: This retrospective study included 365 eyes that underwent PK using corneas from 231 donors between June 2010 and June 2015. Patients were divided into three groups (group 1: primary endothelial diseases; group 2: iatrogenic endothelial disorders; and group 3: other pathologies with a healthy endothelium) according to PK indications. The primary outcome measure was corneal graft survival at the last visit (clear or opaque). Graft clarity was assessed using Kaplan-Meier survival analysis.Results: The most frequent PK indication was keratoconus (KC) (20.5%) followed by pseudophakic bullous keratopathy (PBK) (18.9%). Donor age had a negative impact on endothelial cell density (ECD) measured by an eye bank specular microscope (p < 0.001). Median best-corrected visual acuity in logarithm of the minimum angle of resolution units increased from 2.1 to 0.8 at 1 year after PK (p < 0.001). The clear graft rate was 96.7% at year 1, 88.8% at year 2, and 85.5% at year 3. Overall graft survival was 84.9% during a median of 39 months (range: 24-79 months) of follow-up. A higher graft survival rate (67.2%) was observed in KC compared to PBK during 6 years (p < 0.001). Recipients younger than 50 years of age showed a better graft survival rate than those older than 70 years of age (p = 0.037). Donor ECD, time between excision and death, and preservation time had no significant effect on graft survival. Frequent graft rejection episodes (GREs) and additional procedures during surgery had a negative impact on graft survival (p < 0.001 and p = 0.014, respectively). A worse graft survival was observed in group 2 compared to groups 1 and 3 (p = 0.042).Conclusions: Young recipient age and KC were associated with a better graft survival. Graft endothelial density and preservation time had no impact on graft survival. PBK, low vision at baseline and year 1, frequent GREs, and additional interventions during surgery had a negative impact on graft survivals.
Collapse
Affiliation(s)
- Feyza Gediz
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Bora Yüksel
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Tuncay Küsbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Okan Akmaz
- Department of Ophthalmology, Merkezefendi State Hospital, Manisa, Turkey
| | - Ömer Kartı
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
147
|
Gu ZY, Ye MJ, Ji KK, Liao RF. Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty. Exp Ther Med 2018; 17:495-501. [PMID: 30651827 DOI: 10.3892/etm.2018.6968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to evaluate the efficacy, predictability and safety of astigmatic keratotomy (AK) combined with scleral tunnel incisions in the treatment of high astigmatism after penetrating keratoplasty (PKP). Paired AK combined with scleral tunnel incisions was performed at the steep astigmatic meridian in 8 eyes of 8 patients with high keratometric astigmatism [>5.0 diopters (D)] after PKP. Pre- and post-operative parameters, including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and keratometric astigmatism were evaluated. The Alpins method for vector analysis was used to evaluate the changes in keratometric astigmatism. The results indicated a statistically significant reduction in the mean keratometric astigmatism from 8.16±3.02 D pre-operatively to 2.28±1.07 D at 3 months postoperatively. The mean UCVA improved from 0.95±0.24 logarithm of the minimum angle of resolution (logMAR) pre-operatively to 0.61±0.17 logMAR at 3 months postoperatively (P<0.05). The mean BCVA improved from 0.41±0.18 logMAR pre-operatively to 0.26±0.12 logMAR at 3 months postoperatively (P>0.05). Between 3 and 6 months after the surgery, the keratometric astigmatism remained stable. Alpins vector analysis demonstrated the relative predictability of this combined surgical treatment. The surgically induced astigmatism was significantly correlated with the target induced astigmatism (r=0.76, P<0.05). None of the patients had any severe complications. The present study indicated that AK combined with scleral tunnel incisions is an effective, relatively predictable and safe treatment for high astigmatism after PKP.
Collapse
Affiliation(s)
- Zheng-Yu Gu
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Min-Jie Ye
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Kang-Kang Ji
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Rong-Feng Liao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| |
Collapse
|
148
|
Jullienne R, Garcin T, Crouzet E, He Z, Renault D, Thuret G, Gain P. Evaluation of corneal epithelial wound healing after penetrating keratoplasty in patients receiving a new matrix therapy agent (regenerating agent). Eur J Ophthalmol 2018; 30:119-124. [PMID: 30378440 DOI: 10.1177/1120672118808971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Complete epithelial wound healing is a milestone in early postoperative care after penetrating keratoplasty. The re-epithelialization rate after penetrating keratoplasty was measured in patients receiving a new matrix therapy agent (regenerating agent, Cacicol®) that mimics heparan sulphates. METHODS This was a prospective, open-label, uncontrolled, single-centre observational study. A total of 33 consecutive patients (33 eyes) who underwent an 8.25-mm diameter penetrating keratoplasty were treated with regenerating agent eye drops: one drop in the operating theatre immediately after graft, then on alternate days. Patients were divided into those at low risk (13 patients) and high risk (20 patients) of delayed wound healing, and follow-up was performed by digital slit lamp with fluorescein-dye testing repeated daily at a fixed time. Dye area was measured using ImageJ freeware. The main endpoint was epithelial healing after regenerating agent therapy. RESULTS The mean ± standard deviation time to complete healing for all patients was 2.7 ± 1.1 (median: 3, range: 1-6) days. This was obtained on Day 1 for 15% of patients, Day 2 for 33%, Day 3 for 88%, Day 4 for 94% and Day 6 for 100%. There was no significant difference between low- and high-risk patients. The area of epithelial defect decreased by a mean ± standard deviation of 75% ± 22% between Day 1 and Day 2, corresponding to a mean ± standard deviation wound-healing rate of 11.5 ± 6.5 mm2/D. There were no systemic or local side effects related to regenerating agent. CONCLUSION These preliminary data suggest that regenerating agent could be a useful, non-invasive therapeutic approach in postoperative management of penetrating keratoplasty with the potential to accelerate re-epithelialization.
Collapse
Affiliation(s)
- Rémy Jullienne
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Thibaud Garcin
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Emmanuel Crouzet
- Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Zhiguo He
- Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Didier Renault
- Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France.,Laboratoires Théa, Clermont-Ferrand, France
| | - Gilles Thuret
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France.,Institut Universitaire de France, Paris, France
| | - Philippe Gain
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, IFR 143, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| |
Collapse
|
149
|
Gobeka H, Barut Selver Ö, Palamar Onay M, Eğrilmez S, Yağcı A. Corneal Biomechanical Properties of Keratoconic Eyes Following Penetrating Keratoplasty. Turk J Ophthalmol 2018; 48:171-177. [PMID: 30202612 PMCID: PMC6126104 DOI: 10.4274/tjo.79664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/03/2018] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the corneal biomechanical properties of keratoconic eyes following penetrating keratoplasty (PKP). Materials and Methods Thirty-five patients (70 eyes) were enrolled to this prospective study. Operated and contralateral keratoconic eyes were defined as Group 1 and 2, respectively. All patients underwent ophthalmological examination and measurements of corneal biomechanical properties by Ocular Response Analyzer (ORA), intraocular pressure (IOP) by Goldmann applanation tonometry, and central corneal thickness (CCT) by Pentacam. Shapiro-Wilk W test was performed to test normality of the data. The statistical significance was evaluated with the paired t-test and Wilcoxon signed ranks test. Pearson correlation and Spearman rho tests were used for correlation analysis. Results The average age and male/female ratio were 31.34±11.65 (15-60) years and 21/14, respectively. The mean values of the data obtained from Group 1 and 2 respectively were: corneal hysteresis (CH): 9.35±1.66, 8.18±1.84 mmHg (p=0.013), corneal resistance factor (CRF): 9.48±1.96, 7.14±2.05 mmHg (p<0.001), IOPcc: 16.90±4.32, 14.26±3.69 mmHg (p=0.004), IOPg: 15.45±4.61, 10.91±3.97 mmHg (p<0.001), IOPapl: 14.26±3.11, 13.09±2.54 mmHg (p=0.046), and central corneal thickness (CCT): 545.64±60.82, 442.60±68.14 μM (p<0.001). The positive correlation between CH and CRF was moderate (r=0.444) in Group 1 and strong (r=0.770) in Group 2. There was a moderate negative correlation between CH and IOPcc in both groups (r=-0.426, r=-0.423), but CH was not correlated with IOPg or IOPapl in either group. There were weak to strong positive correlations between CRF and all IOP values in both groups. There was no correlation between CRF and CCT in Group 1 (r=0.075) and a very weak correlation in Group 2 (r=0.237). Only IOPcc and IOPg were strongly correlated in both groups. Conclusion Better understanding of corneal biomechanical properties is essential for elucidating the pathophysiology and diagnosis of several corneal pathologies such as keratoconus. The biomechanical properties of keratoconic eyes seem to be closer to normal values after PKP.
Collapse
Affiliation(s)
- Hamidu Gobeka
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Özlem Barut Selver
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Melis Palamar Onay
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Sait Eğrilmez
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Ayşe Yağcı
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| |
Collapse
|
150
|
Infantes Molina EJ, Celis Sánchez J, Tenias Burilllo JM, Diaz Valle D, Benítez-Del-Castillo JM, Mesa Varona D, Avendaño-Cantos E. Deep anterior lamellar keratoplasty versus penetrating keratoplasty in corneas showing a high or low graft rejection risk. Eur J Ophthalmol 2018; 29:295-303. [PMID: 30175617 DOI: 10.1177/1120672118797287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare visual, topographic and topometric outcomes in patients subjected to deep anterior lamellar keratoplasty or penetrating keratoplasty showing a high or low risk of graft rejection. SETTING Complejo Hospitalario La Mancha Centro, Ciudad Real, Spain. MATERIALS AND METHODS Data were reviewed for consecutive patients with a corneal stroma disease undergoing deep anterior lamellar keratoplasty or penetrating keratoplasty over the period 2009-2015 at our centre by the same surgeon. The outcome measures examined were 2-year follow-up best-corrected visual acuity, refractive error, topographic astigmatism, intraocular pressure, endothelial cell density and central corneal thickness. RESULTS Of 115 eyes enrolled, 46 underwent deep anterior lamellar keratoplasty (15 low risk, 31 high risk) and 69 penetrating keratoplasty (23 low risk, 46 high risk). Mean postoperative best-corrected visual acuity (logMAR) in the low- and high-risk groups, respectively, were 0.31 and 0.26 for deep anterior lamellar keratoplasty (p = 0.32) and 0.40 and 0.51 for penetrating keratoplasty (p = 0.28). The values for the high-risk deep anterior lamellar keratoplasty versus high-risk penetrating keratoplasty patients were 0.26 and 0.51, respectively (p = 0.004). Mean postoperative spherical equivalents were -2.60 D for low-risk deep anterior lamellar keratoplasty versus -2.29 D for high-risk deep anterior lamellar keratoplasty (p = 0.19), and -0.41 D for low-risk penetrating keratoplasty versus -0.13 D for high-risk penetrating keratoplasty (p = 0.51). CONCLUSION Final best-corrected visual acuity and visual acuity gains were better for deep anterior lamellar keratoplasty, mainly in corneas with a high rejection risk. Despite a better corneal thickness recorded in the deep anterior lamellar keratoplasty group, the other variables examined were comparable. Deep anterior lamellar keratoplasty emerged as an effective alternative to penetrating keratoplasty for patients with a disease affecting the corneal stroma.
Collapse
|