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Madsen MBM, Ivarsen A, Telinius N, Hjortdal J. Intraocular pressure-related side-effects after endothelial keratoplasty. Acta Ophthalmol 2024; 102:674-682. [PMID: 38339889 DOI: 10.1111/aos.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/25/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To investigate circumpapillary retinal nerve fibre layer (RNFL) thickness, pupillary function and diameter after phacoemulsification and lens implantation alone or combined with endothelial keratoplasty (EK). METHODS This study was a secondary analysis of data from a randomized, single-masked trial, that included 72 patients with Fuchs' endothelial dystrophy and cataract, equally allocated (1:1) to ultrathin Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty. The cataract extraction (CE) group included 40 patients undergoing cataract surgery only. All patients were treated with phacoemulsification and lens implantation. RESULTS RNFL thickness was significantly lower in the CE group than after EK for the global (p < 0.01), nasal (p = 0.04), and temporal sectors (p = 0.01) 12 months after surgery. RNFL thickness was comparable between patients treated with rebubbling and others (p ≥ 0.16 for all comparisons) after 12 months. The CE group and patients treated with EK demonstrated a comparable scotopic (p = 0.34) and photopic pupil diameter (p = 0.95) as well as a comparable maximum (p = 0.83) and average pupillary constriction velocity (p = 0.95) after 12 months. In contrast, patients treated with rebubbling had a significantly smaller scotopic pupil diameter (p = 0.04). CONCLUSION In this study, no evidence was found indicating a negative impact on the RNFL thickness after EK when compared to CE 12 months after surgery. Iris function and pupil diameter were comparable between the CE group and patients treated with EK after 12 months.
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Affiliation(s)
- Morten B M Madsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Telinius
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Chen H, Wu S, Tian L, Li Y, Hong J, Wang Y, Xu J. Intraocular pressure measurement and association with corneal biomechanics in patients underwent Descemet's stripping with endothelial keratoplasty: a comparative study. Front Med (Lausanne) 2024; 11:1384694. [PMID: 39071083 PMCID: PMC11272548 DOI: 10.3389/fmed.2024.1384694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To compare corneal biomechanical properties and intraocular pressure (IOP) measurements in patients who underwent Descemet's stripping with endothelial keratoplasty (DSEK) with those of the follow healthy eyes. Methods In this retrospective comparative study, a total of 35 eyes of 35 patients who underwent DSEK by a single surgeon from 2015.02 to 2019.12 were enrolled along with their fellow healthy eyes. Corneal biomechanical parameters were assessed at least 3 months post-DSEK using Corneal Visualization Scheimpflug Technology (CST). IOP was measured by CST, Goldmann applanation tonometry (GAT), and MacKay-Marg tonometer. Results Central corneal thickness (CCT) and stiffness parameter at first applanation (SP-A1) were significantly increased after DSEK when compared to the fellow eyes. In DSEK eyes, biomechanically-corrected intraocular pressure (bIOP) and MacKay-Marg IOP correlated significantly with GAT IOP measurements, with bIOP showed the lowest IOP values. All the IOP values did not correlate with CCT. However, GAT-IOP and MacKay-Marg IOP showed a positive correlation with SP-A1. Conclusion The corneal stiffness increased after DSEK. Central corneal thickness may have less influence than corneal biomechanics on IOP measurements in eyes after DSEK. Biomechanically-corrected IOP obtained by CST seemed to be lower than other tonometry techniques in DSEK eyes, perhaps because of correction for corneal stiffness, CCT and age.
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Affiliation(s)
- Huiyu Chen
- Shanghai Eye Diseases Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Suqian Wu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Lijia Tian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yue Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiaxu Hong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yulan Wang
- Shanghai Eye Diseases Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jianjiang Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Science, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Hsueh YJ, Chen HC, Pan YY, Hsiao FC, Yang SJ, Liu MC, Lai WY, Li G, Hui-Kang Ma D, James Meir YJ. The hiPSC-derived corneal endothelial progenitor-like cell recovers the rabbit model of corneal endothelial dystrophy. J Adv Res 2024:S2090-1232(24)00184-X. [PMID: 38729560 DOI: 10.1016/j.jare.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Corneal endothelial dysfunction results in cornea opacity, damaging sightedness, and affecting quality of life. A corneal transplant is the current effective intervention. Due to the scarcity of donated cornea, such an unmet medical need requires a novel therapeutic modality. OBJECTIVES Customizing patients' corneal endothelial progenitor cells with proliferative activity and lineage restriction properties shall offer sufficient therapeutic cells for corneal endothelial dystrophy. METHODS The customized induced human corneal endothelial progenitor-like cell (iHCEPLC) was obtained through cell fate conversions starting from PBMC (peripheral blood mononuclear cell), hiPSC (human induced pluripotent stem cell), and hNCC (human neural crest cell), while it finally reached the iHCEPLC state via a series of induction. Several molecular diagnoses were applied to depict its progenitor state, including RNAseq, FlowCytometer, immunostainings, and rtPCR. Significantly, it can be induced to gain differentiation maturity through contact inhibition. In addition, a BAK-mediated rabbit model of corneal endothelial dystrophy was established in the present study to test the therapeutic effectiveness of the iHCEPLC. RESULTS After inducing cell fate conversion, the specific HCEC markers were detected by rtPCR and immunostaining in iHCEPLC. Further, RNAseq was applied to distinguish its progenitor-like cell fate from primary human corneal endothelial cells (HECE). FlowCytometry profiled the heterogeneity subpopulation, consistently displaying a subtle difference from primary HCEC. A terminal differentiation can be induced in iHCEPLC, addressing its progenitor-like fate. iHCEPLC can restore the BAK-based rabbit model of corneal endothelial dystrophy. Immunohistochemistry verified that such acuity restoration of the BAK-treated cornea is due to the introduced iHCEPLC, and such therapeutic effectiveness is observed in the long term. CONCLUSION Here, we demonstrated that customized iHCEPLC has long-term therapeutic efficacy. As a progenitor cell, our iHCEPLC has a restricted cell lineage nature and can proliferate in vitro, supporting sufficient therapeutic candidate cells. Due to the immune-privileged nature of the cornea, our iHCEPLC proves the principle of therapeutical feasibility in both autogenic and allogeneic modalities.
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Affiliation(s)
- Yi-Jen Hsueh
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Dept. of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Hung-Chi Chen
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Dept. of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yu-Yun Pan
- Dept. of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Fang-Chi Hsiao
- Dept. of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Shun-Jie Yang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Mei-Chun Liu
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Wei-Yu Lai
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Guigang Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province 430030, China
| | - David Hui-Kang Ma
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Dept. of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yaa-Jyuhn James Meir
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan; Dept. of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; Dept. of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan.
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Saini C, Davies EC, Ung L, Chodosh J, Ciolino JB, Jurkunas UV, Paschalis EI, Pineda R, Saeed HN, Yin J, Shen LQ. Incidence and risk factors for glaucoma development and progression after corneal transplantation. Eye (Lond) 2023; 37:2117-2125. [PMID: 36329167 PMCID: PMC10333209 DOI: 10.1038/s41433-022-02299-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess the cumulative incidence and risk factors for glaucoma development and progression within 1-2 years following corneal transplant surgery. DESIGN Retrospective cohort study. METHODS Patients undergoing penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping endothelial keratoplasty (DSEK), Descemet membrane endothelial keratoplasty (DMEK), Boston keratoprosthesis type I (KPro) implantation, or endothelial keratoplasty (DSEK or DMEK) under previous PK (EK under previous PK) at one academic institution with at least 1 year of follow-up were included. Primary outcome measures were cumulative incidence of glaucoma development and progression after corneal transplant, in patients without and with preoperative glaucoma, respectively. Risk factors for glaucoma development and progression were also assessed. RESULTS Four hundred and thirty-one eyes of 431 patients undergoing PK (113), DALK (17), DSEK (71), DMEK (168), KPro (35) and EK under previous PK (27) with a mean follow-up of 22.9 months were analyzed. The 1-year cumulative incidence for glaucoma development and progression was 28.0% and 17.8% in patients without and with preoperative glaucoma, respectively. In a Cox proportional hazards analysis, DSEK surgery, KPro implantation, average intraocular pressure (IOP) through follow-up and postoperative IOP spikes of ≥30 mmHg were each independently associated with glaucoma development or progression (p < 0.04 for all). CONCLUSIONS A significant proportion of patients developed glaucoma or exhibited glaucoma progression within 1 year after corneal transplantation. Patient selection for DSEK may partly explain the higher risk for glaucoma in these patients. Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist.
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Affiliation(s)
- Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Emma C Davies
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ula V Jurkunas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:467-476. [PMID: 36040539 PMCID: PMC9836965 DOI: 10.1007/s00417-022-05813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. DESIGN In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan-Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. RESULTS The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5-63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3-46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3-16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4-24.8]. Independent risk factors for graft failure were the indication for DMEK "status after graft failure" (n = 16) compared to Fuchs' dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054-68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456-27.031]). CONCLUSION The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation-but not trabeculectomy-and DMEK after graft failure increase the risk of graft failure.
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Mansoori T, Mohan GP, Srirampur A, Pesala V. Incidence of Glaucoma after Combined Descemet's Stripping Endothelial Keratoplasty and Retropupillary Fixated Iris-Claw Lens. J Curr Ophthalmol 2022; 34:277-283. [PMID: 36644474 PMCID: PMC9832467 DOI: 10.4103/joco.joco_62_22] [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: 02/19/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the incidence of glaucoma after combined Descemet's stripping endothelial keratoplasty (DSEK) and retropupillary fixated iris-claw intraocular lens (IOL) implantation in the patients with bullous keratopathy (BK) who required secondary IOL or IOL exchange. Methods In this retrospective case series, medical records of 22 patients who underwent combined DSEK and retropupillary fixated iris-claw IOL implantation were evaluated. Preoperative vision, intraocular pressure (IOP), postoperative IOP at different time periods, and intraoperative and postoperative complications were analyzed. Results A total of 22 eyes of 22 patients (7 females and 15 males) were analyzed. The median age was 62 years, and the median duration of the postoperative follow-up was 106.5 days. The corrected distance visual acuity improved from a median of 1.85 logMAR to 1.68 logMAR. None of the patients had intraoperative complications. Three patients (13.6%) had dislocation of the donor tissue on the 1st postoperative day and were successfully rebubbled. Six eyes (27.3%) had graft failure and required penetrating keratoplasty. Eleven eyes (50%) had a sustained rise in the IOP, of which 2 (9.09%) had ocular hypertension and 9 eyes (40.9%) progressed to glaucoma. Conclusions DSEK combined with retropupillary fixated iris-claw lens is a good surgical option for the management of aphakic/pseudophakic BK in patients who require secondary IOL or IOL exchange. Regular IOP monitoring after the surgery is an essential, as there is a risk of IOP rise and glaucoma in the postoperative period. Clinicians should be vigilant and control the IOP to prevent glaucoma progression.
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Affiliation(s)
- Tarannum Mansoori
- Department of Glaucoma, Anand Eye Institute, Hyderabad, Telangana, India,Address for correspondence: Tarannum Mansoori, Department of Glaucoma, Anand Eye Institute, 7-147/1, Nagendra Nagar Colony, Habsiguda, Hyderabad - 500 007, Telangana, India. E-mail:
| | | | - Arjun Srirampur
- Department of Cornea, Anand Eye Institute, Hyderabad, Telangana, India
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Yildiz I, Altan C, Çakmak S, Genc S, Yildirim Y, Agca A. Comparison of Intraocular Pressure Measurements With Goldmann Applanation Tonometry, Tonopen XL, and Pascal Dynamic Contour Tonometry in Patients With Descemet Membrane Endothelial Keratoplasty. J Glaucoma 2022; 31:909-914. [PMID: 35939831 DOI: 10.1097/ijg.0000000000002089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/17/2022] [Indexed: 02/04/2023]
Abstract
PRCIS IOP measured with Tonopen and DCT was higher than GAT in eyes that underwent DMEK. PURPOSE/AIM OF THE STUDY To compare intraocular pressure (IOP) measurements measured based on Goldmann applanation tonometry (GAT), Tonopen XL, and Pascal Dynamic Contour Tonometry (DCT) in patients who had undergone descemet membrane endothelial keratoplasty (DMEK) and to appraise the influence of central corneal thickness (CCT) on IOP measurements. MATERIALS AND METHODS Thirty-four eyes (from 34 patients) who underwent DMEK at least 1 month before the study were included. We performed Tonopen XL, GAT, and DCT IOP measurements at 10 min intervals. Bland-Altman plots were used to assess agreement between GAT, Tonopen XL, and DCT. Spearman rank correlation was used to calculate the deviation from GAT readings by each device and correlate the readings with the CCT variable. RESULTS The mean IOP values with GAT, Tonopen XL, and DCT were 14.9±5.8, 16.2±5.5, and 19.2±5.0, respectively. Statistically significant differences between GAT and Tonopen XL and between GAT and DCT were noted ( r =0.942 [0.885-0.971]; P =0.0001 and r =0.942 [0.885-0.971]; P =0.0001, respectively). DCT tended to return a higher IOP relative to GAT and Tonopen XL. CCT and IOP readings obtained by GAT, Tonopen XL, and DCT did not show a statistically significant correlation with each other. CONCLUSION IOP as measured with both Tonopen and DCT was found to be higher than GAT in eyes that underwent DMEK surgery although the techniques showed a good correlation. After DMEK surgery, all 3 measurement techniques can be practical in routine postoperative examinations, however it is recommended to measure IOP with the same device during patient follow-up.
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Affiliation(s)
- Izlem Yildiz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Glaucoma in Patients With Endothelial Keratoplasty. Cornea 2022; 41:1584-1599. [DOI: 10.1097/ico.0000000000003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
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Shakya R, Ahluwalia NS, Shah C, Mohan A, Parmar G, Gupta A, Gupta RKC, Borde P, Jain BK. Gonioscopic angle evaluation and its correlation with graft survival and post-operative ocular hypertension in patients of Descemet's stripping endothelial keratoplasty. Indian J Ophthalmol 2022; 70:3298-3303. [PMID: 36018107 DOI: 10.4103/ijo.ijo_803_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the gonioscopic changes in patients receiving Descemet's stripping endothelial keratoplasty (DSEK) without pre-existing ocular hypertension (OHT) and to report its correlation with post-surgery OHT, graft survival, and visual outcomes. Methods Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow-up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post-DSEK OHT details were documented. Results A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra-ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid-induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre-operative best corrected visual acuity was 1.62 logMAR (range 1.17-1.77), which gradually improved to 0.79 logMAR (range 0.3-1.77) after 2 years (p < 0.00001). Conclusion PAS was found to be an important factor associated with post-DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.
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Affiliation(s)
- Rakesh Shakya
- Department of Glaucoma, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Navjot Singh Ahluwalia
- Department of Glaucoma, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Chintan Shah
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Amit Mohan
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Gautam Parmar
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Amit Gupta
- Department of Glaucoma, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Ramesh K C Gupta
- Department of Glaucoma, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - Prashant Borde
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
| | - B K Jain
- Department of Quality Assurance, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Satna, Madhya Pradesh, India
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Sridhar U, Tripathy K. Commentary: Ocular hypertension after Descemet's stripping endothelial keratoplasty. Indian J Ophthalmol 2022; 70:3303-3304. [PMID: 36018108 DOI: 10.4103/ijo.ijo_1286_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Uma Sridhar
- Department of Cornea and Cataract, ICARE Eye Hospital and Postgraduate Institute, Noida, Delhi-NCR, India
| | - Koushik Tripathy
- Department of Cornea and Cataract, ICARE Eye Hospital and Postgraduate Institute, Noida, Delhi-NCR; Department of Retina, Uvea, and Cataract, ASG Eye Hospital, Kolkata, West Bengal, India
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Ramyashri S, Mohamed A, Chaurasia S, Senthil S. Comparison of long-term outcomes of trabeculectomy and risk factors for failure in eyes post penetrating keratoplasty or Descemet's stripping endothelial keratoplasty. Indian J Ophthalmol 2022; 70:827-833. [PMID: 35225524 PMCID: PMC9114594 DOI: 10.4103/ijo.ijo_1213_21] [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] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate the outcomes of trabeculectomy, graft survival, and risk factors for failure in post penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) eyes. Methods: We reviewed charts of eyes that underwent trabeculectomy for post keratoplasty glaucoma PK [25 eyes] and DSEK [14 eyes] between 1993 and 2019. The demographics, clinical features, and surgical outcomes were evaluated. Success of trabeculectomy was defined as complete when the intraocular pressure (IOP) was >5 and ≤21 mmHg without antiglaucoma medications (AGM) and qualified with AGM. Clear and compact graft was considered for graft success. Results: Median (interquartile range [IQR] preoperative IOP in post-PK eyes and post-DSEK eyes was comparable, 32 (28–38) vs. 31.5 (25–36) mmHg, P = 0.38). Median number of preoperative AGMs was comparable (P = 0.78). Median postoperative follow-up was longer in post-PK, compared with post-DSEK, 2.5 (1.3–3.3) vs. 1 (0.3–2.9) years (P = 0.05). Kaplan–Meier survival estimates for complete and qualified success of trabeculectomy at 3 years were 23.7% and 73.3%, respectively, for PK and 45.8% and 71.6%, respectively, for DSEK. Kaplan–Meier survival estimates for graft survival were 91.8% up to 3 years for PK and 100% until 2 years and 77.8% at 3 years for DSEK. Higher IOP prior to trabeculectomy was a risk factor for failure of trabeculectomy (P = 0.03) and older age was a risk factor for graft failure (P = 0.05) in PK eyes. Number of prior corneal surgeries (P = 0.05) was associated with failure of trabeculectomy and graft failure in post-DSEK eyes. Conclusion: Trabeculectomy had moderate qualified success in post-PK and DSEK eyes at 3 years. Higher pretrabeculectomy IOP and higher number of prior corneal surgeries were significantly associated with failure of trabeculectomy in PK and DSEK eyes, respectively.
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Affiliation(s)
- S Ramyashri
- VST Centre for Glaucoma, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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12
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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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13
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Kusano Y, Yamaguchi T, Nishisako S, Matsumura T, Fukui M, Higa K, Inoue T, Shimazaki J. Elevated Cytokine Levels in Aqueous Humor Are Associated with Peripheral Anterior Synechiae after Penetrating Keratoplasty. Int J Mol Sci 2021; 22:12268. [PMID: 34830147 PMCID: PMC8618311 DOI: 10.3390/ijms222212268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
Peripheral anterior synechiae (PAS) after corneal transplantation leads to refractory glaucoma and permanent loss of vision. However, the exact mechanism remains elusive. This study aimed to evaluate the association between cytokine levels in the aqueous humor (AqH) and the progression of PAS after penetrating keratoplasty (PKP). We measured 20 cytokine levels in AqH and assessed the correlation with PAS progression after PKP in 85 consecutive patients who underwent PKP. We also evaluated age-dependent alterations in PAS and cytokine levels in DBA2J mice. PAS developed in 38 (44.7%) of 85 eyes after PKP. The incidence of intraocular pressure increase after PKP was significantly greater in eyes with PAS (26.3%) than in those without PAS (2%, p = 0.0009). The PAS area at 12 months after PKP was significantly positively correlated with the preoperative levels of interleukin (IL)-6, interferon (IFN)-γ and monocyte chemotactic protein (MCP)-1 (p ≤ 0.049). In the DBA2J mice, an experimental glaucoma model that developed PAS at 50 weeks, the AqH levels of IL-2, IL-6, IL-10, IFN-γ, tumor necrosis factor-α, MCP-1 and granulocyte-macrophage colony-stimulating factor (GM-CSF) significantly increased at 50 weeks compared to 8 weeks (p ≤ 0.021). In conclusion, inflammatory alterations in the AqH microenvironment, such as high preoperative specific cytokine levels, can lead to PAS formation and glaucoma.
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Affiliation(s)
- Yuki Kusano
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
- Department of Ophthalmology, Kumamoto University, Kumamoto 8608-556, Japan;
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
| | - Sota Nishisako
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
- Cornea Center Eye Bank, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
| | - Masaki Fukui
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
| | - Kazunari Higa
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
- Cornea Center Eye Bank, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Kumamoto University, Kumamoto 8608-556, Japan;
| | - Jun Shimazaki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan; (Y.K.); (S.N.); (T.M.); (M.F.); (K.H.); (J.S.)
- Cornea Center Eye Bank, Ichikawa General Hospital, Tokyo Dental College, Chiba 2728-513, Japan
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14
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Kusano Y, Yamaguchi T, Nishisako S, Matsumura T, Fukui M, Higa K, Inoue T, Shimazaki J. Aqueous Cytokine Levels Are Associated With Progression of Peripheral Anterior Synechiae After Descemet Stripping Automated Endothelial Keratoplasty. Transl Vis Sci Technol 2021; 10:12. [PMID: 34499726 PMCID: PMC8434755 DOI: 10.1167/tvst.10.11.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate the association between total protein and cytokine levels in aqueous humor (AqH) and the progression of peripheral anterior synechiae (PAS) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This prospective study included 146 consecutive patients who underwent DSAEK. Preoperative levels of total protein and 20 cytokines in AqH were measured. Using three-dimensional anterior segment optical coherence tomography, we assessed the iridotrabecular contact (ITC) area before and at 3, 6, and 12 months after DSAEK. Correlations between the total protein and cytokine levels in the AqH and ITC area were analyzed. Results ITC was observed in 47 eyes (32.2%) after DSAEK. The ITC area increased from 2.00 ± 4.42 mm2 preoperatively to 3.00 ± 6.85 mm2 at 12 months. The total protein level in AqH was significantly higher in eyes with ITC progression than in those without (1.45 ± 1.03 mg/mL vs. 1.00 ± 0.57; P = 0.04) and was significantly positively correlated with the progression of ITC area after DSAEK (at 6 months, r = 0.311 and P = 0.005; at 12 months, r = 0.342 and P = 0.0004). The ITC area at 12 months was significantly correlated with the preoperative AqH levels of interleukin-8 (r = 0.252; P = 0.021), interferon-γ (r = 0.318; P = 0.009), and soluble intercellular adhesion molecule-1 (r = 0.292; P = 0.004). Multivariate analyses showed that the total protein levels in AqH and the presence of preoperative ITC were significant risk factors for increased ITC area after DSAEK (β = 0.193–0.574; all P < 0.02). Conclusions Higher preoperative total protein and specific cytokine levels in AqH were associated with ITC formation after DSAEK. Translational Relevance Our findings indicate that chronic pathological changes in AqH can cause PAS progression and glaucoma after DSAEK.
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Affiliation(s)
- Yuki Kusano
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.,Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Sota Nishisako
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.,Cornea Center Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kazunari Higa
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.,Cornea Center Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.,Cornea Center Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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15
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Long-term Results of Intraocular Pressure Elevation and Post-DMEK Glaucoma After Descemet Membrane Endothelial Keratoplasty. Cornea 2021; 40:26-32. [PMID: 32558736 DOI: 10.1097/ico.0000000000002363] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intraocular pressure (IOP) elevation occurs regularly after Descemet membrane endothelial keratoplasty (DMEK). This study evaluated the long-term incidence of IOP elevation and post-DMEK glaucoma after DMEK. METHODS A total of 463 consecutive DMEKs in 352 patients performed between September 2011 and September 2014 at the Universitätsmedizin-Charité Berlin were reviewed. Data of the second treated eye of each patient and of re-DMEKs during the follow-up were excluded. The 12- and 36-month incidence of IOP elevation and post-DMEK glaucoma was analyzed using the Kaplan-Meier survival analysis. IOP elevation was defined as IOP ≥22 mm Hg or ≥10 mm Hg from preoperative baseline. COX regression analysis was used to evaluate the risk factors for IOP elevation and the development of a post-DMEK glaucoma. RESULTS The 12-month incidence of IOP elevation was 15.9% [95 confidence interval (CI), 12.0%-19.8%] and that of post-DMEK glaucoma was 3.9% (95 CI, 1.7%-6.1%); the 36-month incidence was 18.8% (95 CI, 14.5%-23.1%) and that of post-DMEK glaucoma was 6.6% (95 CI, 3.7%-9.5%). The most frequent cause was steroid-induced IOP elevation with a 12-month incidence of 11.7% (95 CI, 8.2%-15.2%) and a 36-month incidence of 12.9% (95 CI, 9.2%-16.6%), respectively. The incidence of postoperative pupillary block IOP elevation was 7.5% (95 CI, 4.8%-10.2%). A preexisting glaucoma increased the risk of IOP elevation [P < 0.001, hazard ratio (HR) 3.331; 95% CI, 1.919-5.782] and the development of a post-DMEK glaucoma (P < 0.001, HR 6.633; 95% CI, 2.556-17.215). The preoperative diagnosis also influenced the risk of IOP elevation [Fuchs corneal dystrophy (FED) vs. bullous keratopathy; P = 0.012, HR 2.354; 95% CI, 1.203-4.608] and post-DMEK glaucoma (FED vs. graft failure; P = 0.01, HR 4.412; 95% CI, 1.419-13.723, FED vs. bullous keratopathy; P = 0.09, HR 2.679; 95% CI, 0.858-8.358). CONCLUSIONS Incidence of IOP elevation is high in the first 12 months after DMEK, especially steroid-induced IOP elevation. Steroid-induced IOP elevation could be treated effectively by tapering down the steroid medication or changing the steroid drug. A preexisting glaucoma and the preoperative diagnosis increase the risk for an IOP elevation and a post-DMEK glaucoma.
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16
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Necip K, Oltulu R, Levent D, Osman GA. Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series. Cornea 2021; 40:1007-1010. [PMID: 33009092 DOI: 10.1097/ico.0000000000002524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS). METHODS Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively. RESULTS There were 8 men and 5 women, with an average age of 56 ± 19 years. The mean follow-up was 8.7 ± 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.±6.6 months (range, 1.5-26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 ± 69 μm) to postoperative last visit (523 ± 71 μm) was statistically significant (P < 0.001). CONCLUSIONS DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.
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Affiliation(s)
- Kara Necip
- Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, Turkey; and
| | - Refik Oltulu
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Dogan Levent
- Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, Turkey; and
| | - Gundogan Ali Osman
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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17
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Anders LM, Gatzioufas Z, Grieshaber MC. Challenges in the complex management of post-keratoplasty glaucoma. Ther Adv Ophthalmol 2021; 13:25158414211031397. [PMID: 34350382 PMCID: PMC8295943 DOI: 10.1177/25158414211031397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.
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Affiliation(s)
- Lisa-Marie Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
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18
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Impact of Early Intraocular Pressure Elevation on Postoperative Outcome After Descemet Membrane Endothelial Keratoplasty in Non-glaucoma Patients. Cornea 2021; 41:83-88. [PMID: 34074893 DOI: 10.1097/ico.0000000000002778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of transient elevations in postoperative intraocular pressure (IOP) on the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) surgery in non-glaucoma patients. METHODS Retrospective analysis from a prospective database of eyes without preexisting glaucoma that underwent DMEK with 90% anterior chamber and 20% sulfur hexafluoride endotamponade. Group A included eyes without postoperative IOP increase (IOP <30 mm Hg and a relative increase from preoperative value <10 mm Hg). Group B included eyes with IOP elevation (postoperative IOP ≥30 mm Hg or a relative increase from preoperative value ≥10 mm Hg) handled according to a standardized protocol. The impact of elevated IOP within 3 days after DMEK surgery was evaluated regarding best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) at 1, 3, and 6 months. RESULTS One hundred seventy-six eyes from 164 patients were included. An IOP increase after DMEK occurred in 20 eyes (11.3%; 19 patients, group B), and the mean peak IOP was 48 ± 12 mm Hg (range 32-69 mm Hg). There were no significant postoperative differences in BCVA, CCT, and ECC on comparing both groups. The BCVA increased significantly (P < 0.001, respectively), whereas CCT (P < 0.001, respectively) and ECC (P < 0.001, respectively) decreased significantly from preoperative values. The rebubbling rate tended to be higher in group B without statistical significance (6.4% vs. 10%, P = 0.648). CONCLUSIONS Temporary IOP elevation after DMEK may not affect functional and morphological outcomes in non-glaucoma patients. However, careful postoperative IOP monitoring and appropriate management are crucial to avoid irreversible ocular damage.
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19
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Elalfy M, Maqsood S, Soliman S, Hegazy SM, Hannon AA, Gatzioufas Z, Lake D, Hamada S. Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty. Clin Ophthalmol 2021; 15:2179-2188. [PMID: 34079216 PMCID: PMC8164721 DOI: 10.2147/opth.s299098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation >21mmHg or ≥6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity. Results The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP>16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP>16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status. Conclusion Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP>16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.
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Affiliation(s)
- Mohamed Elalfy
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Eye Department, Maidstone and Turnbridge Wells Hospital, Maidstone, UK.,Research Institute of Ophthalmology, Giza, Egypt
| | - Sundas Maqsood
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | | | | | | | - Zisis Gatzioufas
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Eye Department, University Hospital Basel, Basel, Switzerland
| | - Damian Lake
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Samer Hamada
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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20
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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] [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.
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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
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21
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Comparison of Intraocular Pressure, Usage of Topical Steroids, Need for Intraocular Pressure Lowering Drops, and Incidence of Glaucoma Surgery Up to 2 Years After Penetrating Keratoplasty and Endothelial Keratoplasty. J Glaucoma 2020; 29:1120-1125. [PMID: 32826764 DOI: 10.1097/ijg.0000000000001635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PRECIS A retrospective review of 239 eyes comparing intraocular pressure (IOP), steroid needs, IOP-lowering drop needs, and incidence of glaucoma surgery between endothelial keratoplasty and penetrating keratoplasties (PKP) at multiple timepoints postoperatively up to 2 years. PURPOSE The purpose of this study was to compare postoperative IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery between PKP, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSEK). MATERIALS AND METHODS A retrospective chart review of all PKP, DMEK, and DSEK surgeries was performed between July 1, 2012 and July 1, 2017 at the University of California, Irvine. Patients with a prior history of glaucoma, corneal or glaucoma surgery, concurrent major or emergent surgery, active infection, and eye disease with synechiae were excluded. A total of 239 patients who underwent PKP (N=127), DMEK (N=46), or DSEK (N=66) were included. IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery were compared at postoperative day 1, postoperative week 1 (POW1), and postoperative month 1 to 24 (POM1-24). RESULTS IOP for PKP was higher than DMEK and DSEK at POW1, POM1, POM6, and POM24 (P<0.05). IOP for PKP was higher than DMEK at POM12 (P=0.028). There was no significant difference in IOP between DMEK and DSEK for all timepoints. PKP required more steroids than DSEK and DMEK at POM3, POM6, POM12, and POM24 (P<0.05). More IOP-lowering drops were required for DSEK than DMEK and PKP at postoperative day 1 and POW1 (P<0.05). More IOP-lowering medications were used for DSEK than DMEK at POM3 and POM12 (P<0.05). About 6% to 7% of patients needed glaucoma surgery by POM24. CONCLUSIONS Endothelial keratoplasties had decreased IOP and steroid needs compared with PKPs postoperatively up to 2 years. The rate of glaucoma surgery and IOP-lowering drop needs were similar between the groups.
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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: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [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.
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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.
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Alio JL, Montesel A, El Sayyad F, Barraquer RI, Arnalich-Montiel F, Alio Del Barrio JL. Corneal graft failure: an update. Br J Ophthalmol 2020; 105:1049-1058. [DOI: 10.1136/bjophthalmol-2020-316705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022]
Abstract
Corneal graft surgery is one of the most successful forms of human solid-tissue transplantation, and nowadays, there is a worldwide expansion of the surgical volume of corneal grafts. This surgery is continuously evolving, with new surgical techniques and postoperative treatments that have considerably increased the chance of survival for the grafts. Despite the high rate of success, corneal transplantation is still complicated by a relevant risk of graft failure. This study investigates the causes that lead to the failure of the different corneal graft surgical techniques and provides an updated synthesis on this topic. A comprehensive review of the main pathological pathways that determine the failure of corneal grafts is provided, analysing the main risk factors and disclosing the survival rates of the principal form of corneal grafts. Our results revealed that penetrating keratoplasty has higher failure rates than lamellar keratoplasty, with immunological rejection being the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders. Postoperative glaucoma and dehiscence of the surgical wound represent other important causes of failure. Endothelial keratoplasty showed the lowest rates of failure in the mid-term, with LEF, detachment of the graft and primary graft failure representing the most common pathological reasons for failure.
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Rodriguez Galarza RM, McMullen RJ. Descemet's membrane detachments, ruptures, and separations in ten adult horses: Clinical signs, diagnostics, treatment options, and preliminary results. Vet Ophthalmol 2020; 23:611-623. [PMID: 32529665 DOI: 10.1111/vop.12793] [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] [Received: 05/22/2019] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnostic imaging results, and treatment outcomes of a series of presumed spontaneous Descemet's membrane detachments (DMD), ruptures, or separations (DMRS) in the adult horse. ANIMALS STUDIED Ten adult horses of various breeds with DMD or DMRS. PROCEDURES Descemet's membrane detachments/DMRS were diagnosed via slit lamp biomicroscopy, ultrasound biomicroscopy (UBM), and/or optical coherence tomography (OCT). Penetrating keratoplasty (PK) with heterologous corneal donor tissue (n = 1), superficial lamellar keratectomy, and Gundersen inlay flaps alone (GF, n = 1) or with subsequent intracamerally assisted corneal tissue welding (CTW, n = 2), or CTW alone (n = 5) were performed in 9/10 horses. One horse underwent spontaneous resolution (n = 1). RESULTS Ten horses were diagnosed with either unilateral DMD (n = 4) or DMRS (n = 6). Seven of ten eyes remained visual during the follow-up period (8.16 ± 6.57 months). Graft transparency was good for the eye treated with PK. The horse that underwent GF alone was functionally blind due to persistent corneal edema. The clinical signs resolved in 3/5 horses that underwent CTW alone, but 2/5 eyes were enucleated due to corneal perforation. Both eyes treated with combined GF/CTW had significant corneal clearing with one having evidence of reattachment on UBM and OCT. CONCLUSIONS Descemet's membrane detachments separations presents differently than typical DMD and advanced corneal imaging modalities may aid in their diagnosis. Corneal tissue welding using infraCG as the photosensitive agent, or in combination with Gundersen inlay flaps, represents a feasible treatment option for management of equine DMD/DMRS as described in the present case series.
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Affiliation(s)
| | - Richard J McMullen
- JT Vaughan Large Animal Teaching Hospital, Auburn University College of Veterinary Medicine, Auburn, AL, USA
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Goldmann Applanation Tonometer Versus Ocular Response Analyzer for Measuring Intraocular Pressure After Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2018; 37:1370-1375. [DOI: 10.1097/ico.0000000000001660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wagoner MD, Bohrer LR, Aldrich BT, Greiner MA, Mullins RF, Worthington KS, Tucker BA, Wiley LA. Feeder-free differentiation of cells exhibiting characteristics of corneal endothelium from human induced pluripotent stem cells. Biol Open 2018; 7:bio032102. [PMID: 29685994 PMCID: PMC5992532 DOI: 10.1242/bio.032102] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to devise a strategy for the derivation of corneal endothelial cells (CEnCs) from adult fibroblast-derived induced pluripotent stem cells (iPSCs). IPSCs were generated from an adult human with normal ocular history via expression of OCT4, SOX2, KLF4 and c-MYC Neural crest cells (NCCs) were differentiated from iPSCs via addition of CHIR99021 and SB4315542. NCCs were driven toward a CEnC fate via addition of B27, PDGF-BB and DKK-2 to CEnC media. Differentiation of NCCs and CEnCs was evaluated via rt-PCR, morphological and immunocytochemical analysis. At 17 days post-NCC induction, there were notable changes in cell morphology and upregulation of the neural crest lineage transcripts PAX3, SOX9, TFAP2A, SOX10 and p75NTR and the proteins p75/NGFR and SOX10. Exposure of NCCs to B27, PDGF-BB and DKK-2 induced a shift in morphology from a spindle-shaped neural phenotype to a tightly-packed hexagonal appearance and increased expression of the transcripts ATP1A1, COL8A1, COL8A2, AQP1 and CDH2 and the proteins ZO-1, N-Cad, AQP-1 and Na+/K+ATPase. Replacement of NCC media with CEnC media on day 3, 5 or 8 reduced the differentiation time needed to yield CEnCs. IPSC-derived CEnCs could be used for evaluation of cornea endothelial disease pathophysiology and for testing of novel therapeutics.
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Affiliation(s)
- Michael D Wagoner
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Laura R Bohrer
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Benjamin T Aldrich
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Lions Eye Bank, Coralville, IA 52241, USA
| | - Mark A Greiner
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Lions Eye Bank, Coralville, IA 52241, USA
| | - Robert F Mullins
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Kristan S Worthington
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Budd A Tucker
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Luke A Wiley
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Rates of Intraocular Pressure Elevation and Use of Topical Antihypertensive Medication After Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2018; 36:669-674. [PMID: 28410361 DOI: 10.1097/ico.0000000000001205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate intraocular pressure (IOP) elevation and medication augmentation after Descemet stripping automated endothelial keratoplasty (DSAEK) in those with and without glaucoma. METHODS The records of 379 patients who underwent DSAEK at the Cleveland Clinic Foundation between January 2009 and 2014 were retrospectively reviewed. Postoperative IOP elevations were considered significant if IOP was ≥22 mm Hg on at least 1 follow-up visit or if it increased by ≥10 mm Hg from baseline. RESULTS The incidence rate of IOP elevation was 4% per person-month (confidence interval [CI], 3%-6%) in patients with preexisting glaucoma and 3% (CI, 2%-4%) in those without. Rates of medication augmentation were 4% per person-month (CI, 3%-5%) in patients with glaucoma and 1.8% (CI, 1.4%-2.4%) in those without. Incidence rates for both outcomes peaked at 1 month. Whites had nearly a 47% lower incidence of IOP elevation compared with nonwhites (P = 0.004); patients with pseudophakic bullous keratopathy had a 54% higher incidence of IOP elevation (P = 0.024); and those with Fuchs endothelial corneal dystrophy had a 36% lower incidence (P = 0.024). Patients with glaucoma had over a 2-fold higher incidence of medication augmentation compared with those without (hazard rate ratio = 2.08, P < 0.001). CONCLUSIONS The incidence of post-DSAEK IOP elevation did not significantly differ by glaucoma status, although patients with glaucoma were more likely to have escalation of topical antihypertensive therapy. The incidence of IOP elevation was significantly associated with pseudophakic bullous keratopathy and nonwhite race. These patients should be followed closely in the early postoperative period, as elevated IOP can be a serious consequence of DSAEK.
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Glaucoma after corneal replacement. Surv Ophthalmol 2017; 63:135-148. [PMID: 28923582 DOI: 10.1016/j.survophthal.2017.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/18/2023]
Abstract
Glaucoma is a well-known complication after corneal transplantation surgery. Traditional corneal transplantation surgery, specifically penetrating keratoplasty, has been slowly replaced by the advent of new corneal transplantation procedures: primarily lamellar keratoplasties. There has also been an emergence of keratoprosthesis implants for eyes that are high risk of failure with penetrating keratoplasty. Consequently, there are different rates of glaucoma, pathogenesis, and potential treatment in the form of medical, laser, or surgical therapy.
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Ohana O, Varssano D, Shemesh G. Comparison of intraocular pressure measurements using Goldmann tonometer, I-care pro, Tonopen XL, and Schiotz tonometer in patients after Descemet stripping endothelial keratoplasty. Indian J Ophthalmol 2017; 65:579-583. [PMID: 28724814 PMCID: PMC5549409 DOI: 10.4103/ijo.ijo_31_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Post-Descemet stripping endothelial keratoplasty (DSEK) patients are prone for intraocular pressure (IOP) elevations and glaucoma. Corneal characteristics influence various IOP measuring devices in various ways. The aim of this study was to evaluate the agreement between four different IOP measuring devices: Goldmann applanation tonometer (GAT), I-care pro, Tonopen XL, and Schiotz tonometr in patients who underwent DSEK. METHODS This was a prospective comparative study using a convenience cohort of post-DSEK patients with compact grafts. Post-DSEK patients had IOP measured using GAT, I-care Pro, Tonopen XL, and Schiotz tonometer. Measurements were compared and agreement assessed. Wilcoxon signed-rank test was used for comparison of means as variables did not show a normal distribution. Bland-Altman plots were used for assessing agreement. RESULTS Thirty eyes of 24 patients were included in the study. Mean time from DSEK surgery was 25.31 ± 13.05 months. Mean IOP with GAT, I-care pro, Tonopen XL, and Schiotz tonometer was 13.99 ± 3.76, 13.92 ± 3.36, 13.31 ± 3.89, and 12.83 ± 4.07, respectively. GAT, I-care pro, and Tonopen XL had similar mean IOP measurements (P = 0.135 and P = 0.551, respectively), while Schiotz tonometry measurements were higher (P = 0.046). Bland-Altman plots show good agreement between GAT, Tonopen XL, and I-care pro. GAT and Schiotz tonometry show less agreement, with large variations in the differences of measured IOP. CONCLUSIONS IOP measurements in post-DSEK patients showed good agreement between GAT and either Tonopen XL or I-care pro. Schiotz tonometer has large variations in this patient group. IOP measurements and IOP difference between devices were not dependent on central corneal thickness.
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Affiliation(s)
- Oded Ohana
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Varssano
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Shemesh
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Kaur M, Titiyal JS, Falera R, Arora T, Sharma N. Outcomes of Descemet Stripping Automated Endothelial Keratoplasty in Toxic Anterior Segment Syndrome After Phacoemulsification. Cornea 2017; 36:17-20. [DOI: 10.1097/ico.0000000000001067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ngai P, Kim G, Chak G, Lin K, Maeda M, Mosaed S. Outcome of primary trabeculotomy ab interno (Trabectome) surgery in patients with steroid-induced glaucoma. Medicine (Baltimore) 2016; 95:e5383. [PMID: 27977576 PMCID: PMC5268022 DOI: 10.1097/md.0000000000005383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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
To determine the efficacy and safety of Trabectome surgery on patients with steroid response, ranging from ocular hypertension refractory to maximal medical therapy to the development of steroid-induced glaucoma.A nonrandomized, nonblinded, retrospective study of 20 subjects with steroid response was conducted. All 20 eyes underwent Trabectome surgery alone. Nine subjects had steroid response with unremarkable visual field, 3 had mild steroid-induced glaucoma, and 8 had advanced steroid-induced glaucoma. Outcome measures included intraocular pressure (IOP), number of glaucoma medications, need for secondary glaucoma surgery, and steroid regimen. Mann-Whitney U test was used to compare postoperative IOP and number of medications to preoperative IOP and number of medications. Kaplan-Meier was used for survival analysis, and success was defined as: IOP reduced by 20% or more on any 2 consecutive visits after 3 months; IOP ≤21 mm Hg on any 2 consecutive visits after 3 months; and no secondary glaucoma surgery.The average preoperative IOP was 33.8 ± 6.9 mm Hg and average preoperative glaucoma medication usage was 3.85 ± 0.75 medications. At 12 months, the IOP was reduced to 15.00 ± 3.46 mm Hg (P = 0.03) and glaucoma medication was reduced to 2.3 ± 1.4 (P < 0.01). The survival rate at 12 months was 93%. At 12 months, 10 patients were continued on their preoperative steroid treatments, 5 were on tapered steroid treatments, and 5 had ceased steroid treatments entirely. One patient required secondary glaucoma surgery (glaucoma drainage device). No other complications were noted.The Trabectome procedure is safe and highly effective for steroid-response glaucoma, even in the context of continued steroid treatment.
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Affiliation(s)
- Philip Ngai
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Grace Kim
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Garrick Chak
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Ken Lin
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | | | - Sameh Mosaed
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
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Achiron A, Blumenfeld O, Avizemer H, Karmona L, Leybowich G, Man V, Bartov E, Burgansky-Eliash Z. Intraocular pressure measurement after DSAEK by iCare, Goldmann applanation and dynamic contour tonometry: A comparative study. J Fr Ophtalmol 2016; 39:822-828. [PMID: 27871779 DOI: 10.1016/j.jfo.2016.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Corneal thickness inevitably increases following Descemet's stripping automated endothelial keratoplasty (DSAEK), owing to the addition of a donor graft. The current study compares different devices in assessing post-DSAEK intraocular pressure (IOP). METHODS We compared IOP values measured by the Goldmann tonometry (GAT), iCare rebound tonometry (iCare) and Pascal dynamic contour tonometry (PDCT) in eyes following DSAEK. Agreement between measurements was calculated with correlation analysis and Bland-Altman plots. Effects of keratometry, central, thickness (CCT), endothelial cell density (ECD) and axial length on IOP measurements were assessed with Pearson's correlation. RESULTS Twenty eyes of 20 patients (mean age 74.3±14.4, 14 females) post-DSAEK were included in this study. There was a high concordance between the IOP readings obtained by the three devices: a strong and significant correlation was found between GAT and PDCT (r=0.94, P<0.001) GAT and iCare (r=0.86, P<0.001) and iCare with PDCT (r=0.81, P<0.001). However, the iCare measurements were significantly and consistently lower than that obtained with GAT (ΔIOP=1.68±2.0, P=0.002, 95% CI: 0.7-2.6) and with PDCT (ΔIOP=1.61±2.5, P=0.01, 95% CI: 0.4-2.8). CCT, ECD, CCT, AXL, corneal curvature or astigmatism did not influence IOP measurement by any instrument. CONCLUSIONS IOP measurement with three different techniques (applanation, rebound and dynamic contour) showed good correlations, despite an increased corneal thickness following DSAEK. However, the iCare, which is based on a rebound tonometry showed significant lower IOP then the two other methods. This should be taken into account when evaluating patients post DSAEK.
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Affiliation(s)
- A Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - O Blumenfeld
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - H Avizemer
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - L Karmona
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - G Leybowich
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V Man
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - E Bartov
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Z Burgansky-Eliash
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Huang OS, Mehta JS, Htoon HM, Tan DT, Wong TT. Incidence and Risk Factors of Elevated Intraocular Pressure Following Deep Anterior Lamellar Keratoplasty. Am J Ophthalmol 2016; 170:153-160. [PMID: 27519560 DOI: 10.1016/j.ajo.2016.07.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence and risk factors of elevated IOP following deep anterior lamellar keratoplasty (DALK). DESIGN A retrospective case series. METHODS A retrospective study investigating the 5-year incidence of raised IOP following DALK cases performed from 2004 to 2008 in a tertiary center. Patients with less than 6 months of follow-up were excluded. Elevated IOP was defined as IOP >21 mm Hg. RESULTS An episode of elevated IOP occurred in 36.1% of cases (44/122 cases), 11.4% (n = 5) occurring within the first week. The average duration of raised IOP was 48.9 (SD: 65.5) days. Causes included pupil block from air, swollen grafts, and corticosteroid response. Surgical intervention to lower IOP was required in 3 cases (6.8%). In multivariate analyses, the use of Olopatadine 0.1% or cyclosporine eye drops before DALK (OR = 14.51, 95% CI = 1.43-147.23) and use of topical prednisolone acetate 1% compared with dexamethasone 0.1% post DALK (OR = 4.79, 95% CI = 0.73-31.52) were associated with higher rates of elevated IOP post DALK. At 5 years post DALK, 3 of 71 cases (4.48%) developed de novo glaucomatous field defects, and 1 case with pre-existing glaucoma had progression of glaucomatous field defect. CONCLUSIONS DALK was associated with a significant incidence of transiently elevated IOP postoperatively, but had a low incidence of de novo glaucoma at 5 years in our study. Risk factors for raised IOP post DALK included the use of topical prednisolone acetate 1% compared with dexamethasone 0.1%, and the use of Olopatadine 0.1% or any concentration of cyclosporine eye drops prior to DALK.
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Affiliation(s)
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Donald T Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tina T Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
PURPOSE OF REVIEW Intraocular pressure (IOP) elevation and glaucoma progression following corneal transplantation, specifically, penetrating keratoplasty, Descemet's stripping endothelial keratoplasty, and Boston keratoprosthesis, are well described causes of ocular morbidity. Depending on the procedure performed, the incidence of glaucoma is highly variable. Several etiologic factors have been identified, the most common being synechial angle closure and corticosteroid-induced IOP elevation. The purpose of this review is to describe the various treatment strategies for glaucoma following corneal transplantation. RECENT FINDINGS Medications and laser treatments are usually first-line therapies for postoperative IOP elevation. Surgical intervention, including filtering surgery and glaucoma drainage devices, may be necessary to control IOP and prevent progressive glaucomatous damage. SUMMARY Glaucoma is a common complication of corneal transplantation, and the degree of aggressiveness is often related to the indication for corneal surgery. Although postoperative IOP elevation may be controlled with medical therapy alone, refractory cases may require glaucoma surgery. In all cases, early detection and intervention are necessary to optimize patient outcomes.
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Elevated Intraocular Pressure in Patients Undergoing Penetrating Keratoplasty and Descemet Stripping Endothelial Keratoplasty. J Glaucoma 2016; 25:390-6. [DOI: 10.1097/ijg.0000000000000251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Glaucoma is the leading cause of irreversible vision loss post-keratoplasty and an important cause of graft failure. With newer techniques, such as lamellar, endothelial, and laser-assisted keratoplasty as well as keratoprosthesis gaining popularity, clinicians will need to consider the incidence, risks, evaluation, and management of glaucoma for each type of keratoplasty when determining which type of transplant may be most appropriate. A comprehensive literature search of glaucoma in the setting of corneal transplantation was performed and serves as the basis for this review. Preexisting glaucoma and aphakia are notable risk factors. Patients that are candidates for deep anterior lamellar keratoplasty may benefit from reduced rates of post-keratoplasty glaucoma. Although glaucoma also complicates eyes with Descemet stripping endothelial keratoplasty, the severity is less and the intraocular pressure is more easily controlled when compared to penetrating keratoplasty. Endothelial keratoplasty creates unique perioperative issues mostly related to management of anterior chamber air bubbles.
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Affiliation(s)
- Ramez I Haddadin
- Massachusetts Eye & Ear Infirmary, Ophthalmology, Cornea & Refractive Surgery Service, Harvard Medical School , Boston, Massachusetts , USA
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39
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Iverson SM, Spierer O, Papachristou GC, Feuer WJ, Shi W, Greenfield DS, O'Brien TP. Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy. Br J Ophthalmol 2015; 99:1477-82. [PMID: 25934845 DOI: 10.1136/bjophthalmol-2014-306547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/29/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Shawn M Iverson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - Oriel Spierer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - George C Papachristou
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - William J Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - Wei Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - David S Greenfield
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
| | - Terrence P O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
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40
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DMEK in phakic eyes: targeted therapy or highway to cataract surgery? Graefes Arch Clin Exp Ophthalmol 2015; 253:909-14. [DOI: 10.1007/s00417-015-2956-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 11/26/2022] Open
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Maurino V, Aiello F. Glaucoma risks in advanced corneal surgery. PROGRESS IN BRAIN RESEARCH 2015; 221:271-95. [DOI: 10.1016/bs.pbr.2015.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Arbelaez JG, Feng MT, Pena TJ, Price MO, Price FW. A year of cornea in review: 2013. Asia Pac J Ophthalmol (Phila) 2015; 4:40-50. [PMID: 26068612 DOI: 10.1097/apo.0000000000000110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The goal of this study was to provide an update of significant corneal literature published in 2013. DESIGN This study is a systematic literature review. METHODS We conducted a systematic review of the English-language literature published from January 1, 2013, to December 31, 2013, using the following PubMed search and Medical Subject Headings terms: cornea transplantation, keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping endothelial keratoplasty, cross linking, pre-Descemet's layer, Rho-associated kinase, keratoprosthesis, infectious keratitis, corneal dystrophy, corneal astigmatism, and keratoconus. RESULTS This review summarizes relevant and innovative original articles, review articles, and novel techniques from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Cornea, Graefe's Archive for Clinical and Experimental Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Journal of Cataract and Refractive Surgery, Journal of Refractive Surgery, and Ophthalmology. Case reports, abstracts, letters to the Editor, and unpublished work were excluded, as well as articles e-published ahead of print in 2012 that were discussed in the previous review. One hundred twenty-seven articles met the criteria for this review. CONCLUSIONS This review summarizes significant cornea-related literature from 2013.
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Affiliation(s)
- Juan G Arbelaez
- From the *Price Vision Group; and †Cornea Research Foundation of America, Indianapolis, IN
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Maier AKB, Gundlach E, Gonnermann J, Klamann MKJ, Eulufi C, Joussen AM, Bertelmann E, Rieck P, Torun N. Anterior segment analysis and intraocular pressure elevation after penetrating keratoplasty and posterior lamellar endothelial keratoplasty. Ophthalmic Res 2014; 53:36-47. [PMID: 25531077 DOI: 10.1159/000365252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 05/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral anterior synechiae (PAS) is a common problem after penetrating keratoplasty (PK) and leads to intraocular pressure (IOP) elevation. This study examines the risk factors for IOP elevation and post-keratoplasty glaucoma. METHODS A retrospective analysis was performed of 47 eyes following PK and of 65 eyes following Descemet's stripping endothelial keratoplasty (DSEK) between 2009 and 2011. The assessment included preoperative history of corneal disease and glaucoma, response to treatment, IOP, and visual acuity. Irido-trabecular contacts (ITC), the angle opening distance (AOD 500) and the anterior chamber angle (ACA 500) were calculated. RESULTS The incidences of IOP elevation and post-keratoplasty glaucoma were 27-36% and 10-29%, respectively. The incidence did not differ significantly between both procedures. Pre-existing glaucoma increased the risk for developing IOP elevation and post-DSEK glaucoma. Eyes with bullous keratopathy (BK) developed significantly more IOP elevation (p = 0.01, d.f. = 1, χ(2) = 6.11) and post-keratoplasty glaucoma (p = 0.01, d.f. = 1, χ(2) = 6.22) than eyes with Fuchs' endothelial dystrophy. Eyes with ITC developed post-keratoplasty glaucoma significantly more often than eyes without ITC (p = 0.01, d.f. = 1, χ(2) = 6.63). CONCLUSION IOP elevation and post-keratoplasty glaucoma showed a high incidence. Risk factors like pre-existing glaucoma, BK and PAS elevated the rate of IOP elevation and post-keratoplasty glaucoma for both procedures.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Maier AKB, Gundlach E, Gonnermann J, Klamann MKJ, Bertelmann E, Rieck PW, Joussen AM, Torun N. Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty. Eye (Lond) 2014; 29:327-32. [PMID: 25412715 DOI: 10.1038/eye.2014.280] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/13/2014] [Indexed: 01/23/2023] Open
Abstract
PURPOSE In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient's satisfaction was evaluated. METHODS A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction. RESULTS Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally. CONCLUSION Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.
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Affiliation(s)
- A-K B Maier
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - E Gundlach
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - J Gonnermann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - M K J Klamann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - E Bertelmann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - P W Rieck
- Eye Clinic am Kapellenberg, Potsdam, Germany
| | - A M Joussen
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
| | - N Torun
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Charité, Germany
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Maier AKB, Wolf T, Gundlach E, Klamann MKJ, Gonnermann J, Bertelmann E, Joussen AM, Torun N. Intraocular pressure elevation and post-DMEK glaucoma following Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2014; 252:1947-54. [DOI: 10.1007/s00417-014-2757-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 07/08/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022] Open
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46
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Graft Survival Versus Glaucoma Treatment After Penetrating or Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2014; 33:785-9. [DOI: 10.1097/ico.0000000000000170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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