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Deitel CM, Chen KH, Uber IC. Possible association of keratoconus progression with gender-affirming hormone therapy: A case report. Am J Ophthalmol Case Rep 2023; 30:101850. [PMID: 37131527 PMCID: PMC10149176 DOI: 10.1016/j.ajoc.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose To present a case of keratoconus progression following gender-affirming hormone therapy. Observations A 28-year-old male-to-female transgender patient with potential past ocular history of subclinical keratoconus presented with subacute worsening myopia of both eyes (OU), 4 months after initiation of gender-affirming hormone therapy. A diagnosis of keratoconus was established based on slit-lamp exam and computerized corneal tomography. Notable indices were central corneal thinning and inferior steepening OU with maximum corneal curvatures of 58.3 D of the right eye (OD) and 77.7 D of the left eye (OS) and thinnest corneal thickness of 440 μm OD and 397 μm OS. After 8 months of continued hormone therapy, the patient's keratoconus continued to progress and thus corneal crosslinking was recommended and performed. Conclusions Keratoconus progression and relapse has been suggested to have an association with sex hormone changes. We report a case of keratoconus progression following gender-affirming hormone therapy in a transgender patient. Our findings continue to support a correlative relationship between sex hormones and corneal ectasia pathophysiology. Further studies are needed to determine causality and to investigate the utility of screening corneal structure prior to the initiation of gender-affirming hormone therapies.
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Affiliation(s)
| | - Kevin H. Chen
- Corresponding author. Kevin Chen Mailing address: Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA.
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Qureshi S, Dohlman TH. Penetrating Keratoplasty: Indications and Graft Survival by Geographic Region. Semin Ophthalmol 2023; 38:31-43. [PMID: 36527378 PMCID: PMC10084850 DOI: 10.1080/08820538.2022.2152710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022]
Abstract
Corneal transplantation, or penetrating keratoplasty (PK), is the most common form of solid-organ transplantation performed worldwide. Here, we evaluated the indications for PK and rates of transplant survival around the world by geographic region. We conducted a literature search of PubMed, MEDLINE, and Google Scholar databases and identified 155 relevant studies from 41 countries published between 1987 and 2021. The most common indications for PK were keratoconus in Europe, Africa, the Middle East, Australia, New Zealand, and Central and South America, bullous keratopathy in North America, and corneal scarring in Asia. The overall global mean graft survival rates at 1-, 2-, 3-, 5-, and 10-years were 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, respectively. Through this systematic analysis of PK by region, we hope to bring a new perspective to the corneal transplantation literature and to potentially highlight global differences and unmet needs in patient care.
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Affiliation(s)
- Sana Qureshi
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Nissen EJ, Saeger M, Nölle B, Roider J. Clinicopathological Correlation of Microbial Keratitis and Ahead: Is There a Corneal Sepsis? Klin Monbl Augenheilkd 2022; 239:857-866. [PMID: 35858596 DOI: 10.1055/a-1811-7171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Microbial, infectious keratitis is a relevant indication for penetrating keratoplasty. The requirement for transplantation results in histopathological examination of the entire thickness of the cornea. Although the clinical diagnosis is not always possible to confirm, pathology can support diagnostic evidence of clinical presentation and pathogenesis. This is achieved with multiple methods from cytology, histochemistry, immunohistology, molecular pathology and in rare cases electron microscopy. These allow tissue-based detection of previous and parallel diseases and the responsible pathogens. The failure of satisfactory clinicopathological correlation raises the question whether a suspected pathogen was not ultimately responsible for destroyed corneal tissue. The pathogenesis of keratitis requiring transplantation is not yet completely understood, also on the experimental level. The development of such a keratitis can lead to a clinical symptomatology which can be described as "threatening organ dysfunction", a term used in sepsis research. Considering recent literature, possible correlations between sepsis and microbial keratitis and their relation to histopathology are discussed.
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Affiliation(s)
- Ebba J Nissen
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Mark Saeger
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Bernhard Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Johann Roider
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
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Liu S, Wong YL, Walkden A. Current Perspectives on Corneal Transplantation. Clin Ophthalmol 2022; 16:631-646. [PMID: 35282172 PMCID: PMC8904759 DOI: 10.2147/opth.s289359] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 12/18/2022] Open
Abstract
Disease of the cornea is the third leading cause of blindness worldwide. Corneal graft surgery is one of the most successful forms of solid organ transplantations in humans, with ever-increasing developments in surgical technique. To date, approximately 4504 corneal transplants are performed in the United Kingdom each year. While full thickness transplantation was the most commonly performed keratoplasty over the last few decades, selective lamellar transplantation of the diseased layers of the cornea has been universally adopted. This comprehensive review aims to provide an updated synthesis on different types of corneal transplantations, their treatment outcomes, and the associated complications of each procedure in both adult and paediatric population. In addition, we also present an up-to-date summary of the emerging therapeutic approaches that have the potential to reduce the demand for donor-dependent keratoplasty.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Correspondence: Andrew Walkden, Email
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HARBİYELİ İİ, ERDEM E, UYSAL A, YAĞMUR M. Penetran keratoplasti endikasyonları: Bir üçüncü basamak sağlık merkezi deneyimi. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.983002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tan H, Lin M, Gou Q, Li A, Gu F, Liu Q, Zhang Q, Xu M, Kijlstra A, Yang P, Li H. Trends in Corneal Transplantation and Characteristics of Donors in the Chongqing Eye Bank, China: A Retrospective Study, 1999-2018. Front Med (Lausanne) 2021; 8:750898. [PMID: 34778313 PMCID: PMC8584146 DOI: 10.3389/fmed.2021.750898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: This study aimed to analyze corneal transplantation trends and voluntary donor characteristics at the Chongqing Eye Bank in China. Methods: We retrospectively reviewed and analyzed data from January 1, 1999, to December 31, 2018, covering 5,397 preregistered voluntary donors, 1,955 actual donors, 3,910 donated tissues, and 2,374 corneal transplantations. Results: The 5,397 preregistered donors included 13 ethnic groups, with an overall mean age of 39.6 years (SD 21.5) and 3,010 were women (55.8%). The most prevalent education level was college and above (2,546, 47.2%), and the most common ethnic group was Han (5,335, 98.85%). Of the 1,955 actual donors, the male-to-female ratio was 3.3, and the mean age was 57.1 (SD 23.0 years). Based on population size in 2018, Jiangbei county was the most active in donation willingness, with ~60 × 10−6 per capita, and the Yuzhong county was the most active in cornea donations, with ~451 × 0−6 per capita. Of the 3,910 donated corneas, 2,540 (65.0%) were clinically used. Of those not used, 978 (71.4%) were rejected for poor corneal quality. The 2,374 (93.5%) corneal transplantation procedures were done at the Department of Ophthalmology of the First Affiliated Hospital of Chongqing Medical University and the rest (n = 166, 6.5%) were performed in other centers. Of those 2,374 corneal transplantations, there were 1,671 penetrating keratoplasty (70.39%), 700 anterior lamellar keratoplasty (29.49%), and three corneal endothelial transplantations in our center (0.13%). The number of annual corneal transplantations increased by nearly 10 times, from 35 cases in 1999 to 327 cases in 2018. Among them, cases of penetrating keratoplasty and anterior lamellar keratoplasty increased from 27, and eight cases in 1999 to 230 and 94 cases in 2018, respectively. Infectious keratitis (37.0%) was the leading indication for keratoplasty, followed by corneal scar (19.8%). Over the study period, corneal scars dropped from the first (41.1% in 1999–2003) to the second indication (20.5% in 2014–2018), while infectious keratitis advanced to take the lead, ranging from 12.2% in 1999–2003 to 26.3% in 2014–2018. Conclusion: Our study reports corneal donation and transplantation trends in Chongqing over 20 years, showing that infectious keratitis is a leading indication for keratoplasty and that penetrating keratoplasty and anterior lamellar keratoplasty show upward trends. The analysis further suggests that a potential preregistered cornea donor is a female Han, with a higher education level.
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Affiliation(s)
- Handan Tan
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Meng Lin
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Qingqing Gou
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Aijia Li
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Fengjuan Gu
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Quan Liu
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Qi Zhang
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Mei Xu
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, Netherlands
| | - Peizeng Yang
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
| | - Hong Li
- Chongqing Key Lab of Ophthalmology, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Eye Institute, Chongqing, China
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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] [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.
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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
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Martin C, Tschernig T, Loic H, Daas L, Seitz B. Corneae from body donors in anatomy department: valuable use for clinical transplantation and experimental research. BMC Ophthalmol 2020; 20:284. [PMID: 32660508 PMCID: PMC7359266 DOI: 10.1186/s12886-020-01546-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Explanted corneae are highly needed for the surgical management of patients with severe corneal diseases. The aim of this study was to determine whether the body donors from the Institute of Anatomy are a suitable source of donor corneae. Methods At the Institute of Anatomy at Saarland University Medical Center in Homburg, corneae are prelevated from body donors who had consented to the removal of tissues for transplantation purposes during their lifetime. Following the report of death, the LIONS Eye Bank is informed and the contraindications of corneal explantation are clarified. Obtaining a blood sample within 24 h postmortem is mandatory. Results The Institute of Anatomy had 150 body donors in the time period from January 2018 to June 2019. Out of these, 68 (45.3%) were reported to the Eye Bank. The age of the donors (median 82 years (range: 57–96)) is not critical since the quality of the corneae depends on the number of endothelial cells (mean: 2109 ± 67 cells/mm2 (range: 511–2944 cells/mm2)). Contraindications were present in 19 (12.6%) cases. The corneae were extracted from 49 (32.7%) body donors. Out of these 98 corneae, 46 (46.9%) were successfully transplanted. Of all non-transplanted corneae, 6 (6.1%) were microbiologically contaminated, 10 (10.2%) had a positive serology, 22 (22.5%) had an endothelial cell count < 2000 cells/mm2 and 6 (6.1%) are at time of this analysis still in culture medium. The non-transplanted tissues were used for research. Conclusions Explanted corneae from the Institute of Anatomy are a valuable option in obtaining grafts for corneal transplantation, which is why we are working toward on expanding cooperation with this department.
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Affiliation(s)
- Cristina Martin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Germany
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Campus Homburg/Saar, Saarland University, Kirrberger Street, Building 61, 66424, Homburg/Saar, Germany.
| | - Hamon Loic
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Germany
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Pluzsik MT, Seitz B, Flockerzi FA, Langenbucher A, Tóth G, Bohle RM, Szentmáry N. Changing Trends in Penetrating Keratoplasty Indications between 2011 and 2018 - Histopathology of 2123 Corneal Buttons in a Single Center in Germany. Curr Eye Res 2020; 45:1199-1204. [PMID: 32114836 DOI: 10.1080/02713683.2020.1737716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To analyse the changing trends in penetrating keratoplasty indications between January 2011 and December 2018, at the Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. Patients and Methods: This is a retrospective review of 2123 corneal buttons of 1776 patients (1993 eyes, 56.0% males, age at the time of surgery 57.6 ± 18.7 years), who underwent penetrating keratoplasty (PKP) between January 2011 and December 2018. The classification was performed based on histological analysis and using the priority scheme of Brady et al., supplemented by a group of "failed endothelial keratoplasty grafts". Our groups were the following: pseudophakic or aphakic bullous keratopathy, regraft, failed endothelial keratoplasty graft, acute necrotizing and ulcerative keratitis, keratoconus, Fuchs' dystrophy, corneal dystrophy other than Fuchs', corneal scars and other diagnoses. Results: Between 2011 and 2018, keratoconus was the leading indication for PKP in 455 (21.5%) cases, followed by acute necrotizing and ulcerative keratitis in 384 (18.1%), regraft in 367 (17.3%), corneal scars in 350 (16.5%), pseudophakic or aphakic bullous keratopathy in 225 (10.6%), Fuchs' dystrophy in 194 (9.1%), other diagnoses in 64 (3.0%), corneal dystrophy other than Fuchs' in 52 (2.4%), and failed endothelial keratoplasty graft in 32 (1.5%) cases. Conclusions: With the introduction of posterior lamellar keratoplasty, keratoconus remains the leading PKP indication in our center with excimer laser-trephination on a routine basis. A trend towards increasing numbers can be observed regarding acute necrotizing and ulcerative keratitis patients and regrafts. However, the incidence of Fuchs' dystrophy decreased dramatically within PKP patients, with the introduction of posterior lamellar keratoplasty.
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Affiliation(s)
- Milán Tamás Pluzsik
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Bajcsy-Zsilinszky Hospital , Budapest, Hungary
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany
| | - Fidelis A Flockerzi
- Department of Pathology, Saarland University Medical Center, UKS , Homburg, Germany
| | | | - Gábor Tóth
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Semmelweis University , Budapest, Hungary
| | - Rainer M Bohle
- Department of Pathology, Saarland University Medical Center, UKS , Homburg, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Semmelweis University , Budapest, Hungary
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Tóth G, Szentmáry N, Langenbucher A, Akhmedova E, El-Husseiny M, Seitz B. Comparison of Excimer Laser Versus Femtosecond Laser Assisted Trephination in Penetrating Keratoplasty: A Retrospective Study. Adv Ther 2019; 36:3471-3482. [PMID: 31650512 DOI: 10.1007/s12325-019-01120-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To compare the impact of non-mechanical excimer-assisted (EXCIMER) and femtosecond laser-assisted (FEMTO) trephination on outcomes after penetrating keratoplasty (PK). METHODS In this retrospective study, 68 eyes from 23 females and 45 males (mean age at time of surgery, 53.3 ± 19.8 years) were included. Inclusion criteria were one surgeon (BS), primary central PK, Fuchs' dystrophy (FUCHS) or keratoconus (KC), no previous intraocular surgery, graft oversize 0.1 mm and 16-bite double running suture. Trephination was performed using a manually guided 193-nm Zeiss Meditec MEL70 excimer laser (EXCIMER group: 18 FUCHS, 17 KC) or 60-kHz IntraLase™ femtosecond laser (FEMTO group: 16 FUCHS, 17 KC). Subjective refractometry (trial glasses) and corneal topography analysis (Pentacam HR; Casia SS-1000 AS-OCT; TMS-5) were performed preoperatively, before removal of the first suture (11.4 ± 1.9 months) and after removal of the second suture (22.6 ± 3.8 months). RESULTS Before suture removal, mean refractive/AS-OCT topographic astigmatism did not differ significantly between EXCIMER and FEMTO. After suture removal, mean refractive/Pentacam/AS-OCT topographic astigmatism was significantly higher in the FEMTO (6.2 ± 2.9 D/7.1 ± 3.2 D/7.4 ± 3.3 D) than in the EXCIMER patients (4.3 ± 3.0 D/4.4 ± 3.1 D/4.0 ± 2.9 D) (p ≤ 0.005). Mean corrected distance visual acuity increased from 0.22 and 0.23 preoperatively to 0.55 and 0.53 before or 0.7 and 0.6 after suture removal in the EXCIMER and FEMTO groups, respectively. Differences between EXCIMER and FEMTO were only pronounced in the KC subgroup. CONCLUSION Non-mechanical EXCIMER trephination seems to have advantages regarding postoperative corneal astigmatism and visual acuity compared with FEMTO trephination, especially in KC. A bigger sample size and longer follow-up are needed to evaluate the long-term impact of EXCIMER and FEMTO trephination on postoperative topographic and visual outcomes.
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Affiliation(s)
- Gábor Tóth
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany.
- Department of Ophthalmology, Semmelweis University, Mária utca 39, 1085, Budapest, Hungary.
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Mária utca 39, 1085, Budapest, Hungary
| | - Achim Langenbucher
- Experimental Ophthalmology, Saarland University, Kirrberger Str. 100, 66424, Homburg/Saar, Germany
| | - Elina Akhmedova
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany
| | - Moatasem El-Husseiny
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg/Saar, Germany
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Bigan G, Puyraveau M, Saleh M, Gain P, Martinache I, Delbosc B, Gauthier AS. Corneal transplantation trends in France from 2004 to 2015: A 12-year review. Eur J Ophthalmol 2018; 28:535-540. [DOI: 10.1177/1120672118762224] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The aim of this study was to report the 12-year longitudinal trends in indication and corneal transplantation techniques in France from 2004 to 2015. Results: The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed. The patient indications and types of transplant performed were analyzed. A total of 46,658 corneal transplantations were performed between 2004 and 2015, with 34,187 (73.3%) penetrating keratoplasty and 10,452 (22.4%) lamellar keratoplasty. The leading surgical indications were secondary endothelial failure (24.3%), keratoconus (18.8%), regraft (13.5%), and Fuchs endothelial corneal dystrophy (15.1%). Endothelial keratoplasty became the preferred technique for endothelial diseases and deep anterior lamellar keratoplasty the preferred technique for keratoconus, surpassing penetrating keratoplasty in 2013. Conclusion: Secondary endothelial failure is the top indication for performing a keratoplasty over the 12-year period. There was a shift from penetrating keratoplasty to endothelial keratoplasty performed for Fuchs endothelial corneal dystrophy and secondary endothelial failure, and to deep anterior lamellar keratoplasty, performed for keratoconus. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.
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Affiliation(s)
- Guillaume Bigan
- Department of Ophthalmology, University Hospital of Besançon, Besançon, France
| | - Marc Puyraveau
- Clinical Trials Statistical, Faculty of Medicine, University of Franche-Comté, Besançon, France
| | - Maher Saleh
- Department of Ophthalmology, University Hospital of Besançon, Besançon, France
| | - Philippe Gain
- Department of Ophthalmology, Saint-Etienne University Hospital, France
| | | | - Bernard Delbosc
- Department of Ophthalmology, University Hospital of Besançon, Besançon, France
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Flockerzi E, Maier P, Böhringer D, Reinshagen H, Kruse F, Cursiefen C, Reinhard T, Geerling G, Torun N, Seitz B. Trends in Corneal Transplantation from 2001 to 2016 in Germany: A Report of the DOG-Section Cornea and its Keratoplasty Registry. Am J Ophthalmol 2018; 188:91-98. [PMID: 29410297 DOI: 10.1016/j.ajo.2018.01.018] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this retrospective panel study was to provide an overview of absolute numbers and of trends in the types of and indications for corneal transplantation in Germany from 2001 to 2016. METHODS A questionnaire about absolute numbers, types of transplantation, and indications was sent to 111 ophthalmologic departments in Germany, out of which 94 (85%) provided their data. RESULTS Since the year 2001, the number of corneal transplantations has increased by 1.5-fold, from 4730 penetrating keratoplasties (PKPs) in 2001 to 7325 penetrating and lamellar keratoplasties in 2016. The shift from penetrating to lamellar procedures began in 2006. In 2014, lamellar procedures (231 [4%] anterior and 2883 [49%] posterior lamellar keratoplasties) surpassed PKPs (2721, 47%) for the first time. Main indications for keratoplasty in Germany (2016) are Fuchs endothelial corneal dystrophy (46%), pseudophakic corneal decompensation (bullous keratopathy, 13%), repeated keratoplasty after graft failure (11%), keratoconus (8%), and corneal scarring (6%; others: 16%). The number of Descemet membrane endothelial keratoplasties (DMEKs) was 12 times higher (3850, 53%) than Descemet stripping automated endothelial keratoplasties (DSAEKs, 319, 4.4%) in 2016. The proportion of deep anterior lamellar keratoplasties (DALKs) never exceeded 6% (269 in 2011). CONCLUSIONS The number of keratoplasties in Germany has increased from 2001 to 2016. Since 2014, posterior lamellar keratoplasties have surpassed PKPs. There was a constant increase of DMEKs, with a 12-fold higher number compared to DSAEKs in 2016. The shorter recovery time after DMEK seems to contribute to the trend toward earlier operative intervention in corneal endothelial diseases.
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An 11-Year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications. Eye Contact Lens 2018; 43:364-370. [PMID: 27203794 DOI: 10.1097/icl.0000000000000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Study aims to evaluate the indications and surgical techniques for corneal transplantation and to report changes in trends for preferred keratoplasty surgical techniques. METHODS Clinical records of 815 consecutive corneal transplantations between January 1, 2004 and December 31, 2014 in Haydarpasa Numune Training and Research Hospital Eye Clinic were analyzed and classified into seven broad groups according to indications. Main outcome measures were change of leading indications and trends for surgical techniques. RESULTS Leading indications for keratoplasty were keratoconus (KCN) (27.7%), bullous keratopathy (BK) (23%), postinfectious corneal scars (13.5%), regrafts (13.1%), corneal dystrophies (12.1%), and noninfectious corneal scars (5.4%). Regrafts were the only indication with a significantly increasing trend (P<0.01). Since the introduction of lamellar keratoplasty (LK) techniques including deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK), there was a significant increasing trend in number and percentage of both LK techniques (DALK; P=0.001 and P=0.007, and DSAEK; P<0.001 and P<0.001, respectively) and a significant corresponding decline in the percentage of penetrating keratoplasty (PK) (P<0.01). Similarly, DALK and DSAEK replaced PK as the preferred surgical technique for KCN and BK indications, (P=0.007 and P=0.01, respectively). Although PK was the most common surgical technique over the 11-year period (54.7%), both anterior and posterior LK techniques showed an emerging trend as the procedures of choice when indicated. CONCLUSIONS No major shift was observed in the clinical indications for corneal transplantation over the previous 11 years, except for regrafts. Lamellar keratoplasty techniques largely overtook the PK technique, but PK was still the overall preferred technique in the era when both LK techniques were used.
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Changing Indications in Penetrating Keratoplasty: A Systematic Review of 34 Years of Global Reporting. Transplantation 2017; 101:1387-1399. [PMID: 27336399 DOI: 10.1097/tp.0000000000001281] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Penetrating keratoplasty (PK) ranks among the oldest and most common kinds of human tissue transplantation. Based on the hypothesis that reported indications for PK significantly vary between global regions and over time, the present systematic review aimed to provide a thorough overview of global PK indications as reported in peer-reviewed manuscripts. METHODS A literature search of PubMed and MEDLINE was conducted to retrieve articles published from January 1980 to May 2014. Indications for PK within 7 global regions were compared using a modified classification system for PK indications and analyzed via multivariate regression. RESULTS A total of 141 publications from 37 countries were included, recording 180 865 PK cases. Postcataract surgery edema was the predominant indication in North America (28.0%) and ranked second in Europe (20.6%), Australia (21.1%), the Middle East (13.6%), Asia (15.5%), and South America (18.6%). Keratoconus was the leading indication in Europe (24.2%), Australia (33.2%), the Middle East (32.8%), Africa (32.4%), and South America (22.8%). It ranked third in North America (14.2%). Keratitis was the primary indication in Asia (32.3%). Fuchs endothelial corneal dystrophy was the fourth most common indication in North America (12.9%) and Europe (10.2%) and fifth in South America (3.8%). Multivariate analysis supported these results and revealed individual regional changes over time. CONCLUSIONS Systematic analysis reveals characteristic chronological and regional differences in reported global PK indications. Leading reported indications for PK between 1980 and 2014 were keratoconus (Europe, Australia, the Middle East, Africa, and South America), pseudophakic bullous keratopathy/aphakic bullous keratopathy (North America), and keratitis (Asia).
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Pekel E, Pekel G. Publication trends in corneal transplantation: a bibliometric analysis. BMC Ophthalmol 2016; 16:194. [PMID: 27821104 PMCID: PMC5100230 DOI: 10.1186/s12886-016-0379-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
Abstract
Background Our aim was to demonstrate the publication trends of corneal transplantation in the last decade. Methods All of the keratoplasty research articles, letters, case reports, reviews and meeting abstracts published between January 2006 and December 2015 indexed on the Thomson Reuters Web of Knowledge were evaluated. A bibliometric filter was used to capture keratoplasty related publications by using the key words ‘keratoplasty’, ‘corneal transplantation’ or ‘keratoprosthesis’ in the ‘title’ selection mode. Results A total of 2726 publications were evaluated in the present study. Documents related to penetrating keratoplasty only have been decreased, whereas the documents related to endothelial keratoplasty were increased in the last decade. The total keratoplasty publication counts had been increased from the year 2006 to 2015. The average citation count per keratoplasty documents was 9.34. Conclusions There is a growing interest to the lamellar keratoplasty techniques especially the endothelial keratoplasty in the last decade.
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Affiliation(s)
- Evre Pekel
- Denizli State Hospital, Eye Clinic, Denizli, Turkey
| | - Gökhan Pekel
- Ophthalmology Department, Pamukkale University, Denizli, 20070, Turkey.
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Le R, Yucel N, Khattak S, Yucel YH, Prud'homme GJ, Gupta N. Current indications and surgical approaches to corneal transplants at the University of Toronto: A clinical-pathological study. Can J Ophthalmol 2016; 52:74-79. [PMID: 28237153 DOI: 10.1016/j.jcjo.2016.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/07/2016] [Accepted: 07/06/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the most common reasons and surgical approaches for corneal graft surgery at the Kensington Eye Institute (KEI), University of Toronto. DESIGN Retrospective cross-sectional study. PARTICIPANTS A total of 229 consecutive corneal transplants performed at the KEI. METHODS Demographic, clinical, and pathological data on all 2012 and 2013 corneal transplants were collected. RESULTS The mean age for corneal transplants was 65 ± 16 years; 39% were full-thickness penetrating keratoplasties (PK) and 61% were partial-thickness. Graft failure (30%), infection (18%), and keratoconus (17%) were the leading indications for PK. Fuchs' dystrophy (40%) and bullous keratopathy (24%) were main causes for partial-thickness procedures. Among partial-thickness approaches, Descemet's stripping automated endothelial keratoplasty (DSAEK), deep anterior lamellar keratoplasty (DALK), and Descemet's membrane endothelial keratoplasty (DMEK) procedures accounted for 68%, 16%, and 16%, respectively. Fuchs' dystrophy (40%) and bullous keratopathy (33%) were the most common indications for DSAEK. Keratoconus (57%) and corneal scarring (35%) were the most common indications for DALK, whereas Fuchs' dystrophy (82%) accounted for most DMEK procedures. The most common reasons for all corneal grafts were Fuchs' dystrophy (25%), bullous keratopathy (21%), graft failure (17%), and keratoconus (12%). CONCLUSIONS Almost two-thirds of all corneal transplant procedures at the University of Toronto are partial thickness procedures. A failed graft was found to be the most common indication for full-thickness transplants. Fuchs' dystrophy was the most common indication for a partial-thickness approach, most often treated by DSAEK. Longitudinal data are needed to determine whether partial-thickness surgeries will improve graft survival and reduce the need for regraft.
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Affiliation(s)
- Ryan Le
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont
| | - Narain Yucel
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Shireen Khattak
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Yeni H Yucel
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont; Ophthalmic Pathology Laboratory, University of Toronto, Toronto, Ont
| | - Gerald J Prud'homme
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Neeru Gupta
- Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont.
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Altay Y, Burcu A, Aksoy G, Ozdemir ES, Ornek F. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014. Clin Ophthalmol 2016; 10:1007-13. [PMID: 27330270 PMCID: PMC4898412 DOI: 10.2147/opth.s102315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. Objective The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. Methods We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2). Patients’ demographic data, indications for corneal transplantation, and the type of surgery were recorded. Results The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%), bullous keratopathy (17%), and non-herpetic corneal scar (13.3%), and between 2005 and 2014, they were keratoconus (33.8%), corneal stromal dystrophy (14.2%), and bullous keratopathy (12.7%). All the keratoplasties performed in the 1995–2004 period were penetrating keratoplasty (PKP). During the period 2005–2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. Conclusion Keratoconus was the leading indication for keratoplasty in both periods. In the 2005–2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP.
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Affiliation(s)
- Yesim Altay
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ayse Burcu
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gozde Aksoy
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Evin Singar Ozdemir
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Firdevs Ornek
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
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Dong PN, Han TN, Aldave AJ, Chau HTM. Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology. Int J Ophthalmol 2016; 9:379-83. [PMID: 27158606 DOI: 10.18240/ijo.2016.03.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology (VNIO) over a period of 12y (2002-2013). METHODS Records of patients who had undergone corneal transplantation at VNIO from January 1, 2002 to January 1, 2014 were reviewed to determine the indication for and type of corneal transplant performed. Patient age, gender, indication for corneal transplantation and surgical technique were recorded and analyzed. RESULTS Corneal transplantation were underwent in 1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review. The most common indication was infectious corneal ulcer (n=670; 48.2%), followed by corneal scar (n=333, 24.0%), corneal dystrophy (n=138, 9.9%) and failed graft (n=112, 8.1%). Nearly all procedures performed were penetrating keratoplasty (n=1300, 93.5%), with a few lamellar keratoplasty procedures performed: lamellar keratoplasty (n=52, 3.7%), Descemet's stripping automated endothelial keratoplasty (n=27, 1.9%) and deep anterior lamellar keratoplasty (n=11, 0.8%). CONCLUSION While the most common indication for keratoplasty was infectious keratitis, nearly all indications for corneal transplantation were managed with penetrating keratoplasty. However, lamellar keratoplasty techniques, including deep anterior lamellar keratoplasty and Descemet's stripping automated endothelial keratoplasty, are being performed with increasing frequency for isolated stromal and endothelial disorders, respectively.
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Affiliation(s)
- Pham Ngoc Dong
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Truong Nhu Han
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Anthony J Aldave
- Stein Eye Institute, the University of California, Los Angeles, CA 90095-7003, USA
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Does Corneal Collagen Cross-linking Reduce the Need for Keratoplasties in Patients With Keratoconus? Cornea 2016; 34:991-5. [PMID: 25970434 DOI: 10.1097/ico.0000000000000460] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate whether the introduction of corneal collagen cross-linking (CXL) influences the frequency of keratoplasties in patients with keratoconus. METHODS Data were obtained from a cohort of patients from our corneal transplant registry. Two different periods were compared, 2005 to 2006 (period 1) and 2013 to 2014 (period 2). Patients during period 1 had surgery before the introduction of CXL treatment, and patients in period 2 had surgery after this treatment was well established in our department. Age and gender were registered, and the Amsler-Krumeich classification system was applied to grade the degree of keratoconus. RESULTS The total number of keratoplasties performed during period 1 was 137, and keratoconus was the cause of surgery in 55 eyes (55 patients). The corresponding numbers in period 2 were 231 and 26 eyes (26 patients), respectively. The difference in the number of keratoplasties for keratoconus in both periods was statistically significant (P = 0.003). There were no significant differences in the distributions of age and gender between both periods. In period 1, 63.6% of the eyes were graded as stage 4 in the Amsler-Krumeich classification, compared with 96.2% in period 2 (P = 0.001). CONCLUSIONS The frequency of keratoplasty for keratoconus has been more than halved in our department over the last decade. There is reason to believe that this reduction is for a great part caused by the introduction of CXL treatment.
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Al-Arfai KM, Yassin SA, Al-Beshri AS, Al-Jindan MY, Al-Tamimi ER. Indications and techniques employed for keratoplasty in the Eastern province of Saudi Arabia: 6 years of experience. Ann Saudi Med 2015; 35:387-93. [PMID: 26506973 PMCID: PMC6074371 DOI: 10.5144/0256-4947.2015.387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Keratoplasty services in Saudi Arabia have progressed steadily in the past few decades. We sought to identify the leading indications and types of keratoplasty performed in the Eastern Province of Saudi Arabia over a six-year period and to compare these indications with published data. DESIGN AND SETTING This was a retrospective descriptive analysis of the records of patients who underwent keratoplasty at four ophthalmology centers in the Eastern Province between 2008 and 2013. PATIENTS AND METHODS All keratoplasty procedures were included in the analysis. The primary surgical indication and type of surgery were identified for each case. RESULTS Keratoplasties included 570 penetrating keratoplasty, 217 deep lamellar keratoplasty, 80 triple procedures, 24 descemet stripping automated endothelial keratoplasty and 12 Boston keratoprosthesis implantations. The mean age of all patients was 28.8 years (range 14-72 years), and 58.9% of the patient were males. The lead.ing indication for keratoplasty was keratoconus 53.10%, bullous keratopathy 13.80%, corneal scarring 10.7%, regrafts 9.1%, and stromal dystrophies 4.9%. CONCLUSIONS In this study, the leading indications for keratoplasty were keratoconus, bullous keratopathy, corneal scarring, regrafts and stromal dystrophies. A significant increasing trend for descemet's stripping automated endothelial keratoplasty surgeries was observed in spite of the number of cases.
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Affiliation(s)
| | - Sanaa A Yassin
- Dr. Sanaa Yassin, Ophthalmology Department,, University of Dammam,, PO Box 40097, Al-Khobar, Eastern Province 31952,, Saudi Arabia, +966-50-4805108,
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Hatipoglu E, Arici C, Arslan OS, Dikkaya F, Sultan P, Kadioglu P, Gundogdu S. Corneal endothelial cell density and morphology in patients with acromegaly. Growth Horm IGF Res 2014; 24:260-263. [PMID: 25174811 DOI: 10.1016/j.ghir.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Acromegaly has various impacts on many organs. The ophthalmologic effects of acromegaly have not yet been investigated in detail. The aim of the current study was to evaluate qualitative and quantitative changes in corneal endothelial cells and central corneal thickness (CCT) of the patients with acromegaly. DESIGN In this prospective, cross-sectional study, 128 eyes of 64 patients with acromegaly (female/male=40/24) and 208 eyes of 104 age and gender-matched healthy volunteers (female/male=69/35) were included. Endothelial cell density (ECD), cellular area (CA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and CCT were measured in patients with acromegaly and in healthy volunteers using the noncontact specular microscopy (SP-3000P: Topcon Corporation, Tokyo, Japan). RESULTS ECD and CA were lower in cases with acromegaly than in controls (ECD in acromegaly: 2615.65 cell/mm(2) and in controls: 2700.35 cell/mm(2); p=0.002. CA in acromegaly: 382.30μm(2) and in controls: 400.30μm(2); p=0.02). In the entire group with acromegaly, the time elapsed since diagnosis was positively correlated with CA and was negatively correlated with ECD (r=+0.39, p=0.001 and r=-0.42, p=0.001). CONCLUSIONS The endothelial layer of the cornea may be under risk of impairment with prolonged disease duration in acromegaly. Consistency of the corneal endothelium should be also sought during long-term follow-up of the cases with acromegaly.
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Affiliation(s)
- Esra Hatipoglu
- Edirne State Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism, Turkey.
| | - Ceyhun Arici
- Istanbul University, Cerrahpasa Medical School, Department of Ophthalmology, Turkey
| | - Osman Sevki Arslan
- Istanbul University, Cerrahpasa Medical School, Department of Ophthalmology, Turkey
| | - Funda Dikkaya
- Istanbul University, Cerrahpasa Medical School, Department of Ophthalmology, Turkey
| | - Pinar Sultan
- Istanbul University, Cerrahpasa Medical School, Department of Ophthalmology, Turkey
| | - Pinar Kadioglu
- Istanbul University, Cerrahpasa Medical School, Department of Internal Medicine, Division of Endocrinology and Metabolism, Turkey
| | - Sadi Gundogdu
- Istanbul University, Cerrahpasa Medical School, Department of Internal Medicine, Division of Endocrinology and Metabolism, Turkey
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Analysis of the changes in keratoplasty indications and preferred techniques. PLoS One 2014; 9:e112696. [PMID: 25386909 PMCID: PMC4227865 DOI: 10.1371/journal.pone.0112696] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background Recently, novel techniques introduced to the field of corneal surgery, e.g. Descemet membrane endothelial keratoplasty (DMEK) and corneal crosslinking, extended the therapeutic options. Additionally contact lens fitting has developed new alternatives. We herein investigated, whether these techniques have affected volume and spectrum of indications of keratoplasties in both a center more specialized in treating Fuchs’ dystrophy (center 1) and a second center that is more specialized in treating keratoconus (center 2). Methods We retrospectively reviewed the waiting lists for indication, transplantation technique and the patients’ travel distances to the hospital at both centers. Results We reviewed a total of 3778 procedures. Fuchs’ dystrophy increased at center 1 from 17% (42) to 44% (150) and from 13% (27) to 23% (62) at center 2. In center 1, DMEK increased from zero percent in 2010 to 51% in 2013. In center 2, DMEK was not performed until 2013. The percentage of patients with keratoconus slightly decreased from 15% (36) in 2009 vs. 12% (40) in 2013 in center 1. The respective percentages in center 2 were 28% (57) and 19% (51). In both centers, the patients’ travel distances increased. Conclusions The results from center 1 suggest that DMEK might increase the total number of keratoplasties. The increase in travel distance suggests that this cannot be fully attributed to recruiting the less advanced patients from the hospital proximity. The increase is rather due to more referrals from other regions. The decrease of keratoconus patients in both centers is surprising and may be attributed to optimized contact lens fitting or even to the effect corneal crosslinking procedure.
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Galvis V, Tello A, Gomez AJ, Rangel CM, Prada4 AM, Camacho PA. Corneal transplantation at an ophthalmological referral center in Colombia: indications and techniques (2004-2011). Open Ophthalmol J 2013; 7:30-3. [PMID: 23898357 PMCID: PMC3722533 DOI: 10.2174/1874364101307010030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/19/2013] [Accepted: 06/20/2013] [Indexed: 11/27/2022] Open
Abstract
Purpose: To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period. Methods: A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011. Results: During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK). Conclusions: Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia ; Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle (FOSCAL), Floridablanca, Colombia ; Health Faculty, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Omar N, Bou Chacra CT, Tabbara KF. Outcome of corneal transplantation in a private institution in Saudi Arabia. Clin Ophthalmol 2013; 7:1311-8. [PMID: 23847410 PMCID: PMC3700911 DOI: 10.2147/opth.s43719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this work was to describe the indications, complications, and outcomes of penetrating keratoplasty (PKP) in Saudi Arabia. Methods In a retrospective, noncomparative interventional case series, the medical records of patients who underwent PKP from January 2000 to December 2008 and had a minimum follow-up of 6 months were reviewed. All corneas were obtained from eye banks in the US. Indications, complications, and outcomes of surgery were recorded. This study was approved by the institutional review board. Results Eighty-five consecutive eyes were included in this study. There were 52 (61.2%) males and 33 (38.8%) females. The median age was 35.0 years (range 3–85 years), and the median follow-up period was 24 months (range 6–108 months). The indications for PKP were keratoconus, bullous keratopathy, corneal scars, corneal dystrophy, and corneal regraft. The overall graft survival time was 88.9 months ± 4.9 months (mean ± standard error of mean, 95% confidence interval [CI] 79.4 months –98.4 months) while the 3-year and 5-year cumulative survival rates were 90.7% and 84.3%, respectively. Surgical indication (P = 0.038), immune rejection (P < 0.001), preoperative corneal vascularization (P = 0.022), and perioperative high intraocular pressure (P = 0.032) were associated significantly with corneal graft failure in univariate analysis. Multivariate analysis reduced these significant associations to rejection (P < 0.001) and vascularization (P = 0.009). Relative risk for failure in rejected cornea was 16.22 (95% CI 4.99–52.69) and in vascularized cornea was 3.89 (95% CI 1.36–11.09). At last visit following PKP, 34 (40%) eyes had best spectacle-corrected visual acuity of 20/40 or better, and 51 (60.0%) eyes had 20/80 or better. Best spectacle-corrected visual acuity was worse than 20/400 in 15 (17.6%) eyes. Conclusion The overall corneal graft survival in a private setting in Saudi Arabia can be excellent. Thorough preoperative evaluation and comprehensive postoperative management are crucial for successful corneal transplantation. A larger multicenter study is recommended to portray the outcome of private corneal transplantation in Saudi Arabia in general.
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Affiliation(s)
- Nazri Omar
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia ; Department of Ophthalmology, Universiti Putra Malaysia, Serdang, Malaysia
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