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Wang J, Jin X, Jin H, Jin D, Zhang H. Loose suture-related ocular surface inflammation and activation of conjunctiva-associated lymphoid tissue in patients after keratoplasty. Sci Rep 2024; 14:10452. [PMID: 38714796 PMCID: PMC11076635 DOI: 10.1038/s41598-024-61346-2] [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: 11/13/2023] [Accepted: 05/05/2024] [Indexed: 05/10/2024] Open
Abstract
The purpose of this study is to evaluate loose suture-related inflammation and activation of conjunctiva-associated lymphoid tissue (CALT) in patients after keratoplasty. The patients who were treated with keratoplasty at the First Affiliated Hospital of Harbin Medical University between 2015 and 2022 were recruited into the study. We evaluated the time and location of loose suture development in patients after keratoplasty. In addition, in vivo confocal microscopy was used to evaluate the activation of CALT and the accumulation of inflammatory cells around loose sutures. Meso Scale Discovery assay detection kits were used to evaluate the inflammatory cytokines in the tears of patients before and after the loose suture was removed. In this study, we collected the information from 212 cases (212 eyes) who had PK (126 eyes) and DALK-treated (86 eyes) for corneal transplantation, including 124 males and 88 females, aged 14-84 years old. The average age was 50.65 ± 16.81 years old. Corneal sutures were more prone to loose at 3 months and 6 months after keratoplasty, and the frequent sites were at 5 and 6 o'clock. An increased number of inflammatory cells could be observed around the loose sutures than normal sutures (P < 0.001). In CALT, the density of diffuse lymphocytes (P < 0.001), follicles (P < 0.001), and parafollicular lymphocytes (P < 0.001) were higher and the central reflection of the follicles (P < 0.001) was stronger when suture loosening happened. The levels of inflammatory cytokines such as IL-1β (P = 0.003), IL-8 (P = 0.012), and TNF-α (P < 0.001) were higher in the tears of the patients with loose sutures. The activation of CALT was partly settled after removing the loose sutures. In conclusion, loose sutures after corneal transplantation can lead to increased infiltration of inflammatory cells, activation of CALT, and increased secretion of inflammatory cytokines in the tears of patients. Regular follow-up to identify and solve the problem in time can avoid suture-related complications.
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Affiliation(s)
- Jingrao Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Hao Jin
- Departments of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Di Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Basic and Clinical Research of Heilongjiang Province, No. 23 Youzheng Road, Harbin, Heilongjiang Province, 150001, People's Republic of China.
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Gour A, Garg A, Tibrewal S, Pegu J, Gupta S, Mathur U, Sangwan V. Corneal transplantation in children - when and how? EXPERT REVIEW OF OPHTHALMOLOGY 2023. [DOI: 10.1080/17469899.2023.2177153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Abha Gour
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Aastha Garg
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology, Strabismus and Neurophthamology, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Julie Pegu
- Department of Glaucoma and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Sonal Gupta
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Umang Mathur
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
| | - Virender Sangwan
- Department of Cornea and Anterior Segment Services, Dr Shroffs Charity Eye Hospital, New Delhi
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Wylęgała A, Roszkowska AM, Kokot J, Dobrowolski D, Wylęgała E. Clinical Evaluation of the Efficacy of Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty. J Clin Med 2023; 12:jcm12031158. [PMID: 36769806 PMCID: PMC9917846 DOI: 10.3390/jcm12031158] [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: 01/06/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To evaluate the clinical outcome, efficacy, and safety of femtosecond laser-assisted anterior lamellar keratoplasty. MATERIAL AND METHODS In this prospective study, 21 males and 10 females aged from 15 to 62 years (mean 38.5) with different pathologies of the anterior corneal layers were enrolled for anterior lamellar keratoplasty using femtosecond laser VisuMax (Carl Zeiss, Germany). All patients were examined for uncorrected (UCVA) and best-corrected (BCVA) distance and near visual acuity, astigmatism, endothelial cell density, corneal thickness, and intraocular pressure. These examinations were performed before transplantation, at hospital discharge, and after 3 and 12 months. The mean follow-up time was 65.36 ± 28.54 months. RESULTS A statistically significant improvement of both UCVA and BCVA for distance and near vision was registered. BCVA improved from 0.11 preoperatively to 0.168 (p = 0.03), 0.267 (p < 0.01), and 0.472 (p < 0.01) on the hospital discharge day, three months, and 12 months respectively. There were no statistically significant differences in astigmatism, intraocular pressure, endothelial cell density, and corneal pachymetry as compared to preoperative and postoperative values. Six patients (19%) had a graft failure with a rate of 33% at 26 months. CONCLUSIONS Femtosecond laser-assisted anterior lamellar keratoplasty is a safe and effective surgical method, providing satisfactory graft survival rates.
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Affiliation(s)
- Adam Wylęgała
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
- Correspondence:
| | - Anna M. Roszkowska
- Ophthalmology Clinic, Department of Biomorphological Sciences, University of Messina, 98124 Messina, Italy
- Ophthalmology Section, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland
| | - Joanna Kokot
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
- Chair and Clinical Department of Ophthalmology, II School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
| | - Dariusz Dobrowolski
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
- Chair and Clinical Department of Ophthalmology, II School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Ophthalmology Clinic of St. Barbara Hospital, 42-200 Sosnowiec, Poland
| | - Edward Wylęgała
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
- Chair and Clinical Department of Ophthalmology, II School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
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Vanathi M, Raj N, Kusumesh R, Aron N, Gupta N, Tandon R. Update on Pediatric Corneal Diseases and Keratoplasty. Surv Ophthalmol 2022; 67:1647-1684. [PMID: 35918016 DOI: 10.1016/j.survophthal.2022.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022]
Abstract
Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties has expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers' compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children is further compromised by the pre-existing amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.
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Affiliation(s)
- Murugesan Vanathi
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India.
| | - Nimmy Raj
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Rakhi Kusumesh
- Cornea & Ocular Surface Services, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neelima Aron
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Noopur Gupta
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Radhika Tandon
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
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Toprak I, Kilic D. Current clinical approach to pediatric keratoconus patients. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2085557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ibrahim Toprak
- Faculty of Medicine, Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey
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Chirurgische Therapieoptionen bei kongenitalen/kindlichen Hornhauttrübungen und Vorderabschnittsdysgenesien. Ophthalmologe 2022; 119:453-461. [DOI: 10.1007/s00347-022-01612-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 12/12/2022]
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Wajnsztajn D, Hopkinson CL, Larkin DFP. Keratoplasty for Keratoconus in Young Patients: Demographics, Clinical Features, and Post-transplant Outcomes. Am J Ophthalmol 2021; 226:68-75. [PMID: 33577788 DOI: 10.1016/j.ajo.2021.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To examine pretransplant findings and outcomes of corneal transplants for keratoconus in children. DESIGN Retrospective cohort (national registry) study. METHODS Data on all patients aged 16 or younger (n = 170) who had a first transplant for keratoconus between 2003 and 2018 in all corneal transplant centers in the UK were compared to adult patients aged 17 and older (n = 7,191). The influence of demographic variables, pretransplant corneal findings, and transplant type on 2-year visual, rejection-free, and transplant survival outcomes was examined. RESULTS Children had poorer pretransplant visual acuity and higher rates of corneal vascularization and ocular surface disease than adults. However, 2-year post-transplant corrected visual acuity reached 20/20 or better in 35% of children compared to 28% of adults (P = .1). Transplant rejection and failure rates were 11% (P = .79) and 3% (P = .31), respectively, for children, which were comparable to rates for adults. Endothelial rejection was reported following penetrating keratoplasty (PK) in 13% of children (10% in adults). Irreversible rejection was not recorded for any transplant in a child. Despite a lack of difference in transplant outcomes, there was a significant age effect in the Cox regression model for transplant rejection, such that for every 5-year increase in age there was a 6% reduction in the hazard of rejection. Transplant survival following anterior lamellar keratoplasty and PK in children was similar. CONCLUSIONS Young keratoconus patients have excellent transplant outcomes and visual results comparable to adults. Overall, the hazard of rejection was found to decrease with advancing age. However, in this large cohort of young patients with keratoconus and poor vision, there is no evidence of outcome advantage in delaying transplant until adult years.
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Affiliation(s)
- Denise Wajnsztajn
- From the Cornea & External Diseases Service, Moorfields Eye Hospital, London, United Kingdom (D.W., D.F.P.L.)
| | - Cathy L Hopkinson
- and NHS Blood and Transplant, Statistics and Clinical Studies, Bristol, United Kingdom (C.L.H.)
| | - Daniel F P Larkin
- From the Cornea & External Diseases Service, Moorfields Eye Hospital, London, United Kingdom (D.W., D.F.P.L.).
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Feizi S, Javadi MA, Karimian F, Abolhosseini M, Moshtaghion SM, Naderi A, Esfandiari H. Penetrating Keratoplasty Versus Deep Anterior Lamellar Keratoplasty in Children and Adolescents With Keratoconus. Am J Ophthalmol 2021; 226:13-21. [PMID: 33529592 DOI: 10.1016/j.ajo.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) for pediatric keratoconus. DESIGN Retrospective comparative interventional case series. METHODS This study included consecutive pediatric keratoconus cases (≤18 years of age) who received PK (n=45) or DALK (n=54) in 2 different time periods. Postoperative best spectacle-corrected visual acuity (BSCVA), refraction, and complications were compared between the study groups. RESULTS The mean follow-up was 83.3±46.1 and 63.3±45.6 months in the PK and DALK groups, respectively (P = .10). Postoperatively, BSCVA was 0.20±0.19 logMAR in the PK group and 0.26±0.19 logMAR in the DALK group (P = .11), with a BSCVA of ≥20/40 in 91.1% and 83.3% of eyes, respectively (P = .25). Two groups were comparable regarding postoperative refractive outcomes. Graft epitheliopathy and suture-associated complications were more commonly encountered after DALK, which was attributable to the effect of low-quality grafts on the clinical outcomes of DALK. Ten PK eyes (22.2%) and 9 DALK eyes (16.7%) experienced at least 1 episode of graft rejection within 5 years of corneal transplantation (P = .49). Rejection was reversible in 93.1% and 100% of episodes in the PK and DALK groups, respectively (P = .63). At the postoperative year 5, 95.6% of grafts in the PK group and 98.2% in the DALK group remained clear (P = .45). CONCLUSION No significant difference was observed in the outcomes between PK and DALK in pediatric keratoconus. Low-quality donor tissues in DALK increased the incidence of graft epithelial problems and suture-related complications as compared to PK.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Javadi
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abolhosseini
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohamadmehdi Moshtaghion
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Naderi
- Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Anitha V, Vanathi M, Raghavan A, Rajaraman R, Ravindran M, Tandon R. Pediatric keratoconus - Current perspectives and clinical challenges. Indian J Ophthalmol 2021; 69:214-225. [PMID: 33463562 PMCID: PMC7933850 DOI: 10.4103/ijo.ijo_1263_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023] Open
Abstract
Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus.
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Affiliation(s)
- Venugopal Anitha
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Tirunelveli, Tamil Nadu, India
| | - Murugesan Vanathi
- Prof of Ophthalmology, Cornea, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anita Raghavan
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Coimbatore, Tamil Nadu, India
| | - Revathi Rajaraman
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Coimbatore, Tamil Nadu, India
| | - Meenakshi Ravindran
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Tirunelveli, Tamil Nadu, India
| | - Radhika Tandon
- Prof of Ophthalmology, Cornea, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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