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Kasamatsu H, Yamaguchi T, Yagi-Yaguchi Y, Nishisako S, Tomida D, Akiyama M, Murata T, Shimazaki J. Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty. Cornea 2024; 43:1008-1014. [PMID: 38049155 DOI: 10.1097/ico.0000000000003444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the incidence and clinical features of immunologic rejection after deep anterior lamellar keratoplasty (DALK). METHODS This study included 411 patients (464 eyes, median age [interquartile range; IQR] 55.8 years [36.1-69.5]) who underwent DALK at Tokyo Dental College between June 1997 and 2021. Of 411 patients, 24 (24 eyes [5.2%], 51.9 years [IQR 31.6-65.4]) developed immunologic rejection. We characterized the clinical features, risk factors associated with immunologic rejection, and prognosis. RESULTS The interval between DALK and immunologic rejection was 14.5 (range, 5-78) months. Immunologic rejection occurred after cessation/reduction of topical steroid in 9 (47.4%) and suture removal in 4 eyes (21.1%). The postoperative duration of topical steroid use in eyes with immunologic rejection was significantly shorter (10.0 months, [IQR 6.0-14.0]) than those without immunologic rejection (28.3 [IQR 15.8-42.7], P = 0.001). Immunologic rejection manifested as stromal edema in 19 (100.0%), ciliary hyperemia in 17 (89.5%), keratic precipitates in 13 (68.4%), epithelial edema in 13 (68.4%), infiltration in 9 (47.4%), corneal opacity in 4 (21.1%), and Descemet membrane detachment in 2 eyes (10.5%). After treatment, corneal clarity was restored in 17 eyes (89.5%); however, immunologic rejection led to corneal endothelial decompensation in 2 eyes (10.5%). Endothelial cell density decreased from 1795.7 ± 722.6 to 1651.6 ± 655.6 cells/mm 2 after immunologic rejection ( P = 0.074). CONCLUSIONS Post-DALK immunologic rejection was associated with specific clinical triggers such as reduction/cessation of topical steroids or suture removal.
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Affiliation(s)
- Hirotsugu Kasamatsu
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Sota Nishisako
- Cornea Center and Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; and
| | - Daisuke Tomida
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masato Akiyama
- Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Hakata, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Milovanova E, Gomon S, Rocha G. Classic lattice corneal dystrophy: a brief review and summary of treatment modalities. Graefes Arch Clin Exp Ophthalmol 2024; 262:1667-1681. [PMID: 37934291 DOI: 10.1007/s00417-023-06297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease. METHODS A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted. RESULTS LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment. CONCLUSIONS This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.
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Affiliation(s)
- Ekaterina Milovanova
- Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Stanislav Gomon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Guillermo Rocha
- Department of Ophthalmology & Visual Sciences, McGill University, Montréal, Canada
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Zhang BN, Qi B, Dong C, Zhang B, Cheng J, Wang X, Li S, Zhuang X, Chen S, Duan H, Li D, Zhu S, Li G, Cao Y, Zhou Q, Xie L. The role of corneal endothelium in macular corneal dystrophy development and recurrence. SCIENCE CHINA. LIFE SCIENCES 2024; 67:332-344. [PMID: 37480470 DOI: 10.1007/s11427-023-2364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/10/2023] [Indexed: 07/24/2023]
Abstract
Macular corneal dystrophy (MCD) is a progressive, bilateral stromal dystrophic disease that arises from mutations in carbohydrate sulfotransferase 6 (CHST6). Corneal transplantation is the ultimate therapeutic solution for MCD patients. Unfortunately, postoperative recurrence remains a significant challenge. We conducted a retrospective review of a clinical cohort comprising 102 MCD patients with 124 eyes that underwent either penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). Our results revealed that the recurrence rate was nearly three times higher in the DALK group (39.13%, 9/23 eyes) compared with the PKP group (10.89%, 11/101 eyes), suggesting that surgical replacement of the corneal endothelium for treating MCD is advisable to prevent postoperative recurrence. Our experimental data confirmed the robust mRNA and protein expression of CHST6 in human corneal endothelium and the rodent homolog CHST5 in mouse endothelium. Selective knockdown of wild-type Chst5 in mouse corneal endothelium (ACsiChst5), but not in the corneal stroma, induced experimental MCD with similar extracellular matrix synthesis impairments and corneal thinning as observed in MCD patients. Mice carrying Chst5 point mutation also recapitulated clinical phenotypes of MCD, along with corneal endothelial abnormalities. Intracameral injection of wild-type Chst5 rescued the corneal impairments in ACsiChst5 mice and retarded the disease progression in Chst5 mutant mice. Overall, our study provides new mechanistic insights and therapeutic approaches for MCD treatment by high-lighting the role of corneal endothelium in MCD development.
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Affiliation(s)
- Bi-Ning Zhang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Benxiang Qi
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Chunxiao Dong
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
- Department of Medicine, Qingdao University, Qingdao, 266071, China
| | - Bin Zhang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Jun Cheng
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Xin Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, 250021, China
| | - Suxia Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, 250021, China
| | - Xiaoyun Zhuang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
- Department of Ophthalmology, School of Clinical Medicine, Weifang Medical University, Weifang, 261072, China
| | - Shijiu Chen
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
- Department of Medicine, Qingdao University, Qingdao, 266071, China
| | - Haoyun Duan
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Dewei Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China
| | - Sujie Zhu
- Institute of Translational Medicine, College of Medicine, Qingdao University, Qingdao, 266071, China
| | - Guoyun Li
- Key Laboratory of Marine Drugs of Ministry of Education, Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266071, China
- Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, 266071, China
| | - Yihai Cao
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, 17177, Sweden
| | - Qingjun Zhou
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China.
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China.
| | - Lixin Xie
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, 266071, China.
- School of Ophthalmology, Shandong First Medical University, Qingdao, 250021, China.
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Cho SY, Yoon JH, Koo MA, Whang WJ, Na KS, Kim EC, Kim HS, Hwang HS. Retrospective Analysis of a New Intrastromal Dissection Technique Using the Retinal Reflex for Deep Anterior Lamellar Keratoplasty. Cornea 2024:00003226-990000000-00456. [PMID: 38251908 DOI: 10.1097/ico.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE The purpose of this study was to describe a new surgical technique for deep anterior lamellar keratoplasty. METHODS All pupils in the recipient eyes were dilated preoperatively. Vertical grooving was performed using a crescent blade with a width of 5 mm and a depth of one-third to half corneal thickness on the temporal side of the limbus. Stromal dissection was performed as close as possible to Descemet membrane by observing the gap between the gold line by retinal reflex and the front edge of the crescent blade. Lamellar dissection was performed along the lamellar plane using corneal dissectors. The ophthalmic viscoelastic device was injected into the intrastromal pocket to separate the anterior and posterior stroma and an anterior corneal lamella was excised. A donor cornea was sutured into the recipient bed. RESULTS In 18 eyes, none of the patients had Descemet membrane rupture during surgery. The mean postoperative residual stromal thickness was 80 ± 31 μm. The mean central corneal thickness after surgery was 660 ± 69 μm. At the last follow-up, the cornea was cleared in all 18 eyes on slit-lamp examination. CONCLUSIONS We estimated the residual stromal thickness based on the gap between the gold line by the retinal reflex and crescent blade, and intrastromal lamellar dissection was performed using a smooth corneal dissector. Consequently, the surface of stromal dissection was smooth, and the residual stromal thickness was even.
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Affiliation(s)
- Soo Yeon Cho
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Borderie VM, Georgeon C, Sandali O, Bouheraoua N. Long-term outcomes of deep anterior lamellar versus penetrating keratoplasty for keratoconus. Br J Ophthalmol 2023; 108:10-16. [PMID: 37890880 PMCID: PMC10803977 DOI: 10.1136/bjo-2023-324230] [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: 07/13/2023] [Accepted: 09/03/2023] [Indexed: 10/29/2023]
Abstract
AIMS To compare the long-term outcomes of deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in keratoconus. METHODS Retrospective comparative case series (228 DALKs and 274 PKs). A biphasic linear model was used to describe the postoperative outcome of the endothelial cell density (ECD). Visual acuity, specular microscopy, corneal topography and optical coherence tomography findings were recorded. RESULTS Graft survival of the 502 keratoconus eyes was 96.7 at 10 years and 95.6% at 20 years. Visual acuity improved from 20/378±5.1 lines preoperatively to 20/32±2.1 lines at 30 months. The corneal ECD decreased from 2494±382 cells/mm2 to 1521±659 cells/mm2 at 10 years. The mean simulated keratometry increased from 44.88±2.54 D at 1 year to 46.60±3.0 D at 3 years. The mean follow-up was 103.4 months for DALKs and 106.1 months for PKs. The cumulated incidence of postoperative ocular hypertension requiring treatment was significantly higher in PKs than in DALKs. The early- and late-phase rates of ECD loss were significantly lower in DALKs than in PKs. These figures in DALKs were 50% of those observed in PKs. The simulated mean keratometry was significantly higher in DALKs than in PKs in the mid but not in the long term. No significant differences in visual acuity were observed between both groups. Manual dissection-DALK featured slower visual recovery than PK and big bubble-DALK, whereas big bubble-DALK and PK featured similar visual recovery. CONCLUSIONS DALK featuring higher endothelial survival and lower risk of postoperative ocular hypertension may be superior to PK when indicated for keratoconus.
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Affiliation(s)
- Vincent Michel Borderie
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - Cristina Georgeon
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - Otman Sandali
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - N Bouheraoua
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
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Ashena Z, Niestrata M, Tavassoli S. Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty. Vision (Basel) 2023; 7:vision7010022. [PMID: 36977302 PMCID: PMC10059954 DOI: 10.3390/vision7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal and stromal corneal dystrophies: namely Reis–Bücklers, Thiel–Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. Due to the anterior location of the deposits in Reis-Bücklers and Thiel–Behnke dystrophies, PTK is considered the treatment of choice. For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.
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Affiliation(s)
- Zahra Ashena
- Ophthalmology Department, Queen’s Hospital, Barking, Havering and Redbridge University NHS Hospitals Trust, Romford RM7 0AG, UK
- Correspondence: ; Tel.: +01708-435000
| | - Magdalena Niestrata
- Moorfields Reading Centre and Clinical AI Hub, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London EC1V 2PD, UK
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Galindo-Bocero J, García-Martínez I, Portillo M, Hernando Acero I, García-González N. Clinical and genetical diagnosis of a case of Meretoja syndrome and frontotemporal lifting procedure. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:583-586. [PMID: 36114141 DOI: 10.1016/j.oftale.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
A 56-year-old male with family background of corneal dystrophy presents with poor subjective vision. Biomicroscopy reveals bilateral reticular stromal dystrophy and facial inspection shows signs of muscle dysfunction, such as eyebrow ptosis, weakness and sagging of the frontal muscles, redundant skin on the forehead and skin hyperelasticity. The patient is referred to Plastic Surgery for evaluation of the frontal muscle involvement, undergoing a frontotemporal lifting procedure. On the other hand, genetics confirms the pathogenic variant c.640G>A (p.Asp214Asn) in the GSN gene, encoding gelsolin, a mutation associated with Finnish-type familial amyloidosis or Meretoja syndrome.
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Affiliation(s)
- J Galindo-Bocero
- Servicio de Oftalmología, Fundación Hospital de Jove, Gijón, Spain.
| | - I García-Martínez
- Servicio de Cirugía Plástica y Reparadora, Fundación Hospital de Jove, Gijón, Spain
| | - M Portillo
- Servicio de Cirugía Plástica y Reparadora, Fundación Hospital de Jove, Gijón, Spain
| | - I Hernando Acero
- Unidad de Genética, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - N García-González
- Unidad de Genética, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
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Arora R, Gupta I, Sahu J, Vishwanath S, Gupta P, Jain P. Corneal aberrations, densitometry on scheimpflug imaging, and visual acuity after deep anterior lamellar keratoplasty. Eur J Ophthalmol 2022; 33:11206721221128863. [PMID: 36172635 DOI: 10.1177/11206721221128863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate visual acuity, corneal aberrations, and densitometry post deep anterior lamellar keratoplasty (DALK). METHODS Twenty-five eyes of 25 patients who underwent DALK for corneal stromal diseases with normal endothelium were enrolled in a prospective interventional study. Evaluation for corneal aberrations and densitometry postoperatively was performed using Scheimpflug imaging at 6 months. Anterior Segment Optical Coherence Tomography (ASOCT) was done for host-graft morphology. Correlation analysis of postoperative best-corrected visual acuity with corneal aberrations and corneal densitometry (CD) was performed. RESULTS Big bubble deep anterior lamellar keratoplasty (BB-DALK) was successful in 18 patients, while 7 eyes underwent manual dissection due to failed BB (Big Bubble) technique. The mean BSCVA was 1.35 ± 0.46 logMAR units pre-operatively which improved to 0.36 ± 0.19 logMAR units post DALK at 6 months (P < 0.001). The mean Root Mean Square (RMS) (μm) of the magnitude of total corneal aberrations, HOA and LOA from central 6mm zone of cornea were 14.6 ± 9.2, 4.7 ± 2.9, and 13.8 ± 8.8, respectively. The mean anterior (120μm), central and posterior corneal (60μm) densitometry in 0-2mm zone were 25.8 ± 7.7 GSU, 18.7 ± 4.16 GSU and 10.09 ± 3.9 GSU respectively. A statistically significant correlation of postoperative residual stromal bed thickness, total corneal HOA, LOA, total corneal aberrations, HOA front and posterior corneal densitometry (0-2mm zone) with postoperative BSCVA was found. CONCLUSION Though there is a significant improvement in BSCVA after DALK, the quality of vision in terms of aberrometry and densitometry is suboptimal, especially in cases undergoing manual DALK compared to those undergoing big bubble formation.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Isha Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Jigyasa Sahu
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shweta Vishwanath
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Palak Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Parul Jain
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
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Mahendra S, Killani S, Pola S. A study of visual outcome in deep anterior lamellar. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Xue J, Wang H, Wang M, Zeng Q, Jhanji V, Kim AD, Wang MTM, Xu Y, Jin X, Chen W. Comparison of deep anterior lamellar keratoplasty and corneal cross-linking in patients with advanced keratoconus. Jpn J Ophthalmol 2021; 66:52-57. [PMID: 34843024 DOI: 10.1007/s10384-021-00888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare outcomes of deep anterior lamellar keratoplasty (DALK) and corneal cross-linking (CXL) in patients with advanced keratoconus, with the primary aim of assessing CXL as a potential therapeutic alternative. STUDY DESIGN Retrospective, multi-center, comparative study. METHODS Patients with advanced keratoconus (maximum keratometry reading (K-max) > 58D, best spectacle-corrected visual acuity worse than 0.52logMAR), undergoing either DALK or CXL treatment at four tertiary ophthalmic centers in Wenzhou, Hangzhou, Nanjing and Wuhan were included. Visual acuity, refractive error, corneal topography and complications were evaluated at baseline and at least 2 year postoperatively. RESULTS 75 eyes of 72 patients were included, of which 37 eyes underwent DALK and 38 eyes, CXL. A larger reduction in Kmax was observed in the DALK group (-18.18 ± 9.44 D versus -1.10 ± 2.70D, p < 0.001). Seven eyes (18%) in the CXL group showed progression of keratoconus. No disease progression was observed in the DALK group. Greater improvements in best spectacle-corrected visual acuity (logMAR) were observed in the DALK group (-0.59 ± 0.25 versus -0.24 ± 0.44, p < 0.001). CONCLUSIONS Compared to CXL, DALK leads to larger reductions in Kmax and better improvement in visual acuity in advanced keratoconus.
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Affiliation(s)
- Jinsong Xue
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiou Wang
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Min Wang
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Qingyan Zeng
- Central South University Aier School of Opthalmology, Changsha, Hunan, China
| | - Vishal Jhanji
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andy D Kim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Yingnan Xu
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiuming Jin
- Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang, People's Republic of China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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AlAraj A, AlAmeer A, Al-Swailem S. Medium-Term Clinical Outcomes of Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty for Macular Corneal Dystrophy. Clin Ophthalmol 2021; 15:3139-3145. [PMID: 34326629 PMCID: PMC8315771 DOI: 10.2147/opth.s317971] [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: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the postoperative outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for macular corneal dystrophy (MCD). Design Single-center, retrospective, interventional case series. Methods A chart review was performed of 100 patients (157 eyes) who underwent primary DALK (DALK group) and PKP (PKP group) for histopathologically confirmed MCD for whom at least 12 months of follow-up were available. Between-group comparisons were performed of visual acuity (VA), graft survival, and postoperative complications. Results There were 22 eyes in the DALK group and 135 in the PKP group. Postoperative best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 90.9% of the DALK group and 76.3% of the PKP group (P=0.12). At last visit, graft survival was 95.5% (21 eyes) and 91.1% (123 eyes) in DALK and PKP groups, respectively (P=0.69, Log rank test). Corneal graft rejection episodes occurred in 1 (4.5%) DALK graft and 19 (14.1%) PKP grafts. Five of the 19 graft rejections in the PKP group were irreversible. Microbial keratitis and cataract occurred in 6 (4.5%) and 15 (11.1%) PKP eyes. One (4.5%) eye in the DALK group had cataract and none of the DALK cases developed microbial keratitis. Clinically significant recurrence was observed in 4 (2.9%) PKP eyes and 1 (4.5%) DALK eye (P=0.69), respectively. Conclusion DALK is a viable option for MCD without Descemet membrane involvement. DALK had comparable medium-term visual and survival outcomes to PKP. DALK has the advantage of lower open sky intraoperative complications and lower graft rejection episodes.
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Affiliation(s)
- Ahmad AlAraj
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.,Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Ahmad AlAmeer
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.,Ophthalmology Division, Surgery Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Samar Al-Swailem
- Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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12
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Singh S, Das S, Kannabiran C, Jakati S, Chaurasia S. Macular Corneal Dystrophy: An Updated Review. Curr Eye Res 2021; 46:765-770. [PMID: 33171054 DOI: 10.1080/02713683.2020.1849727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/11/2023]
Abstract
Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.
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Affiliation(s)
- Shalini Singh
- Cornea and Anterior Segment Services, LVPEI, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment Services, LVPEI, Bhubneshwar, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
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13
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Abdelaal AM, Alqassimi AH, Malak M, Hijazi HT, Hadrawi M, Khan MA. Indications of Keratoplasty and Outcomes of Deep Anterior Lamellar Keratoplasty Compared to Penetrating Keratoplasty. Cureus 2021; 13:e13825. [PMID: 33859889 PMCID: PMC8040744 DOI: 10.7759/cureus.13825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Corneal diseases are a significant cause of visual impairment and blindness. Despite the treatable nature of many corneal diseases before visual demise, many cases of advanced disease necessitating keratoplasty for visual rehabilitation are encountered. A mismatch between the number of corneal donors and potential recipients also exists worldwide, with underutilization of certain types of keratoplasty techniques that may allow more efficient use of this limited resource. Methodology A retrospective cohort study of all cases of optical corneal transplantations performed from January 1, 2015 to October 31, 2020 was performed. Indications for keratoplasty, type of keratoplasty, complications, intraocular pressure elevation, and best corrected visual acuity (BCVA) by category and range at different time intervals were collected and analyzed. Findings were compared between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) for all indications, specifically for keratoconus (KCN). Results A total of 58 corneal transplants meeting our criteria were performed during the study period. PK was performed for 29 eyes, DALK for 28 eyes, and endothelial keratoplasty for one eye. The most frequently encountered indication was KCN (62.1%). The number of eyes with BCVA of 20/100 or better increased from preoperative BCVA, 37/58 eyes had BCVA worse than 20/100 before keratoplasty (63.8%), while at the time of last follow-up 45/58 eyes had BCVA of 20/100 or better (77.6%). At the time of last follow-up 16/58 had BCVA in the range of 20/20 to 20/40 (27.6%) and 29/58 eyes had BCVA in the range of 20/50 to 20/100 (50%). Comparison of all cases of PK to DALK for all indications showed significantly better BCVA by category at one year, at last follow-up, and BCVA range at last follow-up (p = 0.032, 0.001, and 0.014, respectively). Although better visual acuity results by category and range at one year and last follow-up, respectively, were observed in more patients undergoing DALK than PK, for KCN the results were not statistically significant (p = 1.00, 1.00, 0.417, and 0.374, respectively). Overall, 70% of recorded complications, intraocular pressure (IOP) elevations, and graft rejections were seen in eyes that underwent PK; however, these findings were not statistically significant (p = 0.297). Graft failures occurred more frequently with PK than deep anterior keratoplasty when analyzed for all indications of keratoplasty (p = 0.010). Conclusions Despite advancement and improvements in surgical techniques, statistics continue to show underutilization of the invaluable resource of donor corneas, with PK still being performed more than DALK for diseases that do not affect the endothelium. Our study found superior visual acuity outcomes of DALK as well as the advantages of less frequent complications, IOP elevations, graft rejections, and graft failures. We encourage ophthalmologists to utilize DALK in appropriate candidates to more fully utilize the scarce and potentially vision-restoring resource of donor corneal tissue.
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Affiliation(s)
- Ahmed M Abdelaal
- Surgery/Ophthalmology, King Saud Bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Jeddah, SAU.,College of Medicine, Alfaisal University, Riyadh, SAU
| | - Albaraa H Alqassimi
- Department of Ophthalmology/Cornea and Anterior Segment Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Mohammad Malak
- Department of Ophthalmology/Cornea and Anterior Segment Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Hassan T Hijazi
- Department of Ophthalmology/Ophthalmologist, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Manal Hadrawi
- Department of Ophthalmology/Pediatric Ophthalmology and Strabismology Consultant, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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14
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Nielsen NS, Poulsen ET, Lukassen MV, Chao Shern C, Mogensen EH, Weberskov CE, DeDionisio L, Schauser L, Moore TC, Otzen DE, Hjortdal J, Enghild JJ. Biochemical mechanisms of aggregation in TGFBI-linked corneal dystrophies. Prog Retin Eye Res 2020; 77:100843. [DOI: 10.1016/j.preteyeres.2020.100843] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/17/2020] [Accepted: 01/23/2020] [Indexed: 12/22/2022]
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15
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Kodavoor SK, Deb B, Ramamurthy D. Deep anterior lamellar keratoplasty outcomes in macular and granular corneal dystrophy - A comparative cross-sectional study. Indian J Ophthalmol 2020; 67:1830-1833. [PMID: 31638043 PMCID: PMC6836615 DOI: 10.4103/ijo.ijo_1623_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the functional and anatomical outcomes (in terms of graft uptake and rejection/failure) of deep anterior lamellar keratoplasty (DALK) in stromal corneal dystrophy (macular and granular). Methods Sixteen eyes with macular corneal dystrophy (MCD; group A) and 10 eyes with granular corneal dystrophy (GCD; group B) underwent successful DALK by big bubble technique or layer-by-layer dissection. Results Both groups showed significant improvement in their best-corrected visual acuity postoperatively (postoperative P value in MCD and GCD was 0.00001 and 0.0008, respectively) with no statistically significant differences between the two groups (P = 0.77) at 1 year. Postoperative endothelial count did not drop significantly in group A (MCD, P= 0.1553). Only in seven eyes preoperative endothelial count could be obtained (due to dense stromal corneal opacity), but there was a significant endothelial count difference between preoperative and postoperative count in group B (GCD, P= 0.0405) at the end of 1 year postoperatively which could be because of age and stage of disease (advanced granular dystrophy) and also because of small sample size of GCD compared with MCD. Intergroup comparison between the two groups showed no statistically significant difference (P = 0.6353) with good postoperative outcome in both groups. Conclusion DALK can be successfully done in both groups and results are comparable. However, long-term outcomes on a large scale need to be further evaluated.
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Affiliation(s)
- Shreesha Kumar Kodavoor
- Department of Cornea, Cataract and Refractive Services, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India
| | - Bijita Deb
- Department of Cornea, Cataract and Refractive Services, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India
| | - Dandapani Ramamurthy
- Department of Cornea, Cataract and Refractive Services, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India
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16
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Chaurasia S, Mishra DK. Atypical presentation of macular corneal dystrophy managed by Descemet stripping endothelial keratoplasty. Indian J Ophthalmol 2019; 67:118-119. [PMID: 30574906 PMCID: PMC6324110 DOI: 10.4103/ijo.ijo_602_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sunita Chaurasia
- Cornea and Anterior Segment Services, Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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17
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Impact of Corneal Higher-Order Aberrations on Visual Acuity After Deep Anterior Lamellar Keratoplasty in Treating Keratoconus. Eye Contact Lens 2018; 45:238-245. [PMID: 30362972 DOI: 10.1097/icl.0000000000000561] [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 evaluate the incidence of the Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in treating keratoconus. We also evaluated the influence of DM folds and corneal higher-order aberrations (HOAs) on visual acuity after DALK. METHODS This retrospective study included 89 consecutive eyes of 87 patients who underwent DALK for the treatment of keratoconus at Tokyo Dental College Ichikawa General Hospital from April 2002 to June 2017. The presence or absence of DM folds was determined by slitlamp microscopy. Visual acuity after DALK was compared between the eyes with and without DM folds. Corneal HOAs of the anterior and posterior surfaces and the total cornea were measured by anterior segment optical coherence tomography. Correlations among the presence of DM folds, corneal HOAs, and visual acuity were analyzed. RESULTS The Descemet membrane folds developed in 28.1% (25/89) eyes after DALK for the treatment of keratoconus. However, there were no significant differences in postoperative visual acuity between the eyes with and without DM folds at 1, 3, 6, and 12 months (P=0.739, P=0.106, P=0.223, and P=0.186, respectively). The visual acuity at 12 months was significantly correlated with corneal HOAs within a 4-mm diameter (anterior surface: R=0.546, P=0.003; total cornea: R=0.506, P=0.007). CONCLUSIONS Larger corneal HOAs, but not the presence of DM folds, were associated with poor visual acuity after DALK. In treating advanced keratoconus with DALK, it is important to minimize postoperative corneal HOAs, although DALK improves visual acuity by reducing HOAs due to keratoconus.
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18
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Aggarwal S, Peck T, Golen J, Karcioglu ZA. Macular corneal dystrophy: A review. Surv Ophthalmol 2018; 63:609-617. [DOI: 10.1016/j.survophthal.2018.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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19
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Chaurasia S, Ramappa M, Murthy S, Garg P. Primary graft failure after big bubble deep anterior lamellar keratoplasty in macular corneal dystrophy. Indian J Ophthalmol 2018; 66:1196-1197. [PMID: 30038180 PMCID: PMC6080430 DOI: 10.4103/ijo.ijo_220_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Macular corneal dystrophy is autosomal recessive dystrophy characterized by deposits of abnormal glycosaminoglycans in stromal lamellae and within endothelial cells. Deep anterior lamellar keratoplasty is successful in the management of this dystrophy. We herein describe three cases of primary graft failure after uneventful big bubble deep anterior lamellar keratoplasty for macular corneal dystrophy.
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Affiliation(s)
- Sunita Chaurasia
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Muralidhar Ramappa
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila Murthy
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Prashant Garg
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
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20
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Mohamed A, Chaurasia S, Ramappa M, Murthy SI, Garg P. Outcomes of keratoplasty in lattice corneal dystrophy in a large cohort of Indian eyes. Indian J Ophthalmol 2018; 66:666-672. [PMID: 29676312 PMCID: PMC5939160 DOI: 10.4103/ijo.ijo_1150_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the outcomes of keratoplasty for lattice corneal dystrophy (LCD) performed at a tertiary eye care center. Methods: A retrospective review of medical records of those patients who were clinically diagnosed to have LCD (72 eyes of 57 patients) and underwent either penetrating keratoplasty (PK, 58 eyes of 46 patients) or deep anterior lamellar keratoplasty (DALK, 14 eyes of 13 patients) between the years 1987 and 2014 was performed. The main outcome measures included demographics, clinical features, and outcomes of keratoplasty. Results: The median follow-up after keratoplasty was 3.1 years (interquartile range [IQR], 9 months to 9 years). The median best-corrected visual acuity (BCVA) was 0.18 (IQR, 0.10–0.48) (Snellen equivalent 20/30 [IQR, 20/25–20/60]) at 4 years postoperatively and 0.65 (IQR, 0.18-0.95) (Snellen equivalent 20/89 [IQR, 20/30–20/178]) at 10 years following surgery. DALK eyes had a significantly better BCVA than PK eyes at 2 years following keratoplasty. The median overall survival of grafts was 15.8 years. Late complications included recurrence of LCD (14 eyes), graft infiltrate (23 eyes), graft rejection (15 eyes), graft failure (16 eyes), and glaucoma (14 eyes). Conclusion: The outcomes of graft are similar following PK and deep anterior lamellar keratoplasty; however, the latter appears to provide slightly better visual outcome. Recurrence of dystrophy in the graft and graft infiltrates limit the overall graft survival in both the groups.
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Affiliation(s)
- Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | | | | | - Prashant Garg
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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21
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Microbubble technique in failed deep anterior lamellar keratoplasty: 2-year outcomes. Eur J Ophthalmol 2018; 28:243-245. [DOI: 10.5301/ejo.5001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To compare the long-term results of big-bubble technique and microbubble techniques to complete stroma dissection after failure of achieving a big-bubble. Methods: A total of 35 eyes with keratoconus underwent lamellar keratoplasty with the big-bubble technique (15 eyes) or the microbubble technique (15 eyes). Conversion to penetrating keratoplasty was performed in 3 eyes of the big-bubble group and in 2 eyes of the microbubble group. Best-corrected visual acuity, corneal thickness, corneal astigmatism, and endothelial cell count were assessed preoperatively and at 12 and 24 months after surgery. Results: Mean preoperative visual acuity was 0.29 ± 0.18 in the big-bubble group and 0.25 ± 0.15 in the microbubble group. Postoperatively, all patients showed a regular interface between donor and recipient tissue. At 24 months, mean best-corrected visual acuity was 0.84 ± 0.16 in the big-bubble group and 0.68 ± 0.17 in the microbubble group (p = 0.013), and mean central corneal thickness was 530 ± 39 µm in the big-bubble group and 545 ± 30 µm in the microbubble group. Astigmatism was 2.41 ± 1.29 D and 3.59 ± 1.48 D (p = 0.036), respectively, while endothelial cell density was 1,671 ± 371 in the big-bubble group and 1,567 ± 275 in the microbubble group. Conclusions: The microbubble technique appears to be a valid alternative as it was safe and provided good functional results.
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22
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Arora R. Deep anterior lamellar keratoplasty or penetrating keratoplasty in lattice corneal dystrophy. Indian J Ophthalmol 2018; 66:673-674. [PMID: 29676313 PMCID: PMC5939161 DOI: 10.4103/ijo.ijo_393_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology, Division of Cornea and Refractive Surgery, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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23
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Excimer Laser Mushroom Penetrating Keratoplasty: New Technique. Eur J Ophthalmol 2018; 24:186-90. [DOI: 10.5301/ejo.5000347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/20/2022]
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Bond P, Bond P, Malle VD, Fanini F, Nardi-Pantoli A. Enzymatic Descemetic Lamellar Keratoplasty: Pilot Study. Eur J Ophthalmol 2018; 20:879-84. [DOI: 10.1177/112067211002000511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paolo Bond
- Department of Ophthalmology, S. Maria della Scaletta Hospital, Imola (Bologna) - Italy
| | - Paola Bond
- Department of Ophthalmology, S. Maria della Scaletta Hospital, Imola (Bologna) - Italy
| | - Vincenzo Delia Malle
- Department of Ophthalmology, S. Maria della Scaletta Hospital, Imola (Bologna) - Italy
| | - Francesca Fanini
- Department of Ophthalmology, S. Maria della Scaletta Hospital, Imola (Bologna) - Italy
| | - Angela Nardi-Pantoli
- Department of Ophthalmology, S. Maria della Scaletta Hospital, Imola (Bologna) - Italy
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25
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Shin S, Bae JK, Ahn Y, Kim H, Choi G, Yoo YS, Joo CK, Moon S, Jung W. Lamellar keratoplasty using position-guided surgical needle and M-mode optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-7. [PMID: 29235270 DOI: 10.1117/1.jbo.22.12.125005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/20/2017] [Indexed: 05/12/2023]
Abstract
Deep anterior lamellar keratoplasty (DALK) is an emerging surgical technique for the restoration of corneal clarity and vision acuity. The big-bubble technique in DALK surgery is the most essential procedure that includes the air injection through a thin syringe needle to separate the dysfunctional region of the cornea. Even though DALK is a well-known transplant method, it is still challenged to manipulate the needle inside the cornea under the surgical microscope, which varies its surgical yield. Here, we introduce the DALK protocol based on the position-guided needle and M-mode optical coherence tomography (OCT). Depth-resolved 26-gage needle was specially designed, fabricated by the stepwise transitional core fiber, and integrated with the swept source OCT system. Since our device is feasible to provide both the position information inside the cornea as well as air injection, it enables the accurate management of bubble formation during DALK. Our results show that real-time feedback of needle end position was intuitionally visualized and fast enough to adjust the location of the needle. Through our research, we realized that position-guided needle combined with M-mode OCT is a very efficient and promising surgical tool, which also to enhance the accuracy and stability of DALK.
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Affiliation(s)
- Sungwon Shin
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
| | - Jung Kweon Bae
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
| | - Yujin Ahn
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
| | - Hyeongeun Kim
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
| | - Geonho Choi
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
| | - Young-Sik Yoo
- Catholic University of Korea, College of Medicine, Department of Ophthalmology and Visual Science, S, Republic of Korea
| | - Choun-Ki Joo
- Catholic University of Korea, College of Medicine, Department of Ophthalmology and Visual Science, S, Republic of Korea
| | - Sucbei Moon
- Kookmin University, Department of Physics, Seoul, Republic of Korea
| | - Woonggyu Jung
- Ulsan National Institute of Science and Technology, Department of Biomedical Engineering, Ulsan, Republic of Korea
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Di Zazzo A, Bonini S, Crugliano S, Fortunato M. The challenging management of pediatric corneal transplantation: an overview of surgical and clinical experiences. Jpn J Ophthalmol 2017; 61:207-217. [PMID: 28374268 DOI: 10.1007/s10384-017-0510-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Pediatric keratoplasty is an immense challenge because of the technical complexity of the procedure and the high risk of rejection in young graft recipients. Our aim is to describe the major indications and appropriate timing of corneal transplantation intervention, including a report of our experience and surgical tips, in conjunction with the current literature. METHODS Review of the literature on indications for keratoplasty in pediatric patients classified as: congenital, traumatic and acquired non-traumatic opacities. We additionally explored the challenges corneal surgeons face in performing this type of surgery and review the most pressing transplant-related problems and their management. RESULTS Outcomes after pediatric keratoplasty, in terms of visual development, restoration and clarity of the graft, are influenced by peri-operative local and systemic conditions and factors, and by intraoperative management of the transplantation procedure itself. CONCLUSION Pediatric corneal transplantation is a critical tool for visual restoration and development in young patients with corneal opacities, particularly during the critical period of visual development. Successful management of the significant challenges associated with pediatric keratoplasty requires customized clinical and surgical management of each patient with particular attention paid to proper post-operative rehabilitation.
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Affiliation(s)
- Antonio Di Zazzo
- IRCCS G.B. Bietti Foundation ONLUS, via Livenza n.3, 00198, Rome, Italy.
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
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27
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Utility of Anterior Segment Optical Coherence Tomography in the Management of Corneal Transplantation. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Borderie VM, Loriaut P, Bouheraoua N, Nordmann JP. Incidence of Intraocular Pressure Elevation and Glaucoma after Lamellar versus Full-Thickness Penetrating Keratoplasty. Ophthalmology 2016; 123:1428-34. [PMID: 27126929 DOI: 10.1016/j.ophtha.2016.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To analyze the cumulated incidence of glaucoma after penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK). DESIGN Cohort study. Data were recorded prospectively and analyzed retrospectively. PARTICIPANTS A total of 1657 consecutive eyes of 1657 patients undergoing corneal transplantation between 1992 and 2013. METHODS Penetrating keratoplasty (date range, 1992-2013), ALK (date range, 2002-2013), and Descemet's stripping automated EK (date range, 2006-2013). MAIN OUTCOME MEASURES Postoperative intraocular pressure (IOP), glaucoma treatments, and glaucoma-related loss of vision (loss of central visual function resulting in absence of light perception or light perception limited to the temporal visual field). Cox proportional hazard regression model was used to analyze risk factors for glaucoma after keratoplasty. RESULTS The 10-year cumulated incidence of elevated IOP and elevated IOP requiring treatment was 46.5% and 38.7%, respectively. In multivariate analysis, 4 variables were significantly associated with a higher incidence of elevated IOP requiring treatment after keratoplasty: preoperative glaucoma or IOP >20 mmHg (adjusted hazard ratio [HR], 1.56; P < 0.001), penetrating keratoplasty (PK) (adjusted HR, 1.12 vs. ALK and 1.10 vs. EK; P < 0.001), postoperative lens status (adjusted HR vs. phakic eyes: 1.15 for posterior chamber intraocular lens, 1.43 for anterior chamber intraocular lens [IOL], 2.83 for aphakic eyes; P < 0.001), and IOL exchange or removal during surgery (adjusted HR, 1.48; P < 0.001). Recipient age, preoperative diagnosis, filtering surgery before keratoplasty, vitrectomy associated with keratoplasty, and filtering surgery associated with keratoplasty were significantly associated with a higher incidence of elevated IOP requiring treatment after keratoplasty in univariate analysis but not in multivariate analysis. The 10-year probability of loss of vision related to glaucoma was 1.0% after EK, 2.1% after ALK, and 3.6% after PK (P = 0.036). CONCLUSIONS The incidence of elevation of IOP after keratoplasty and development of glaucoma are significantly decreased with ALK and EK compared with PK. We believe this is due to diminished surgery-induced damage to the anterior chamber angle and trabecular meshwork, and reduced postoperative use of steroids.
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Affiliation(s)
- Vincent M Borderie
- Quinze-Vingts National Eye Hospital, UPMC Univ Paris 06-Sorbonne Universities, Paris, France.
| | - Patrick Loriaut
- Quinze-Vingts National Eye Hospital, UPMC Univ Paris 06-Sorbonne Universities, Paris, France
| | - Nacim Bouheraoua
- Quinze-Vingts National Eye Hospital, UPMC Univ Paris 06-Sorbonne Universities, Paris, France
| | - Jean-Philippe Nordmann
- Quinze-Vingts National Eye Hospital, UPMC Univ Paris 06-Sorbonne Universities, Paris, France
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Femtosecond Laser-Assisted Lamellar Keratectomy for Corneal Opacities Secondary to Anterior Corneal Dystrophies: An Interventional Case Series. Cornea 2016; 35:6-13. [PMID: 26509759 DOI: 10.1097/ico.0000000000000665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report results of femtosecond laser-assisted lamellar keratectomy (FLK) for corneal opacities secondary to anterior corneal dystrophies. METHODS Patients with a clinical diagnosis of Reis-Bücklers corneal dystrophy, granular corneal dystrophy, lattice corneal dystrophy, and macular corneal dystrophy were treated. FLK was performed to remove a central corneal free cap of 9.5 mm in diameter at a depth of 110 to 140 μm on which histological analysis was undertaken. Preoperative and postoperative refraction, best spectacle-corrected visual acuity, corneal topography results, and color photographs were recorded. Postoperative in vivo confocal microscopy of the cornea was performed. Changes in uncorrected visual acuity and best spectacle-corrected visual acuity, keratometry, refractive error, corneal irregularity, residual or recurrent central corneal opacities, and corneal haze were used to assess the outcome. RESULTS Eight eyes of 6 patients were treated. The clinical diagnosis was confirmed histologically in all cases. Visual acuity improved significantly from 0.49 ± 0.2 logMAR to 0.14 ± 0.13 logMAR after a mean follow-up of 29 ± 14 (range 8-54) months. Residual central stromal opacities were noted in 5 of 8 eyes immediately postoperatively. Clinically significant recurrence of disease was noted in 1 eye. Keratometry and refraction remained stable, and no further surgical intervention was needed. Patients with stromal corneal dystrophies had worse outcome than those with Reis-Bücklers corneal dystrophy. CONCLUSIONS In this case series, FLK provided both therapeutic and diagnostic intervention, delaying more invasive surgery. In vivo confocal microscopy showed signs of postoperative corneal stromal neuropathy.
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Pathogenesis and treatments of TGFBI corneal dystrophies. Prog Retin Eye Res 2015; 50:67-88. [PMID: 26612778 DOI: 10.1016/j.preteyeres.2015.11.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
Abstract
Transforming growth factor beta-induced (TGFBI) corneal dystrophies are a group of inherited progressive corneal diseases. Accumulation of transforming growth factor beta-induced protein (TGFBIp) is involved in the pathogenesis of TGFBI corneal dystrophies; however, the exact molecular mechanisms are not fully elucidated. In this review article, we summarize the current knowledge of TGFBI corneal dystrophies including clinical manifestations, epidemiology, most common and recently reported associated mutations for each disease, and treatment modalities. We review our current understanding of the molecular mechanisms of granular corneal dystrophy type 2 (GCD2) and studies of other TGFBI corneal dystrophies. In GCD2 corneal fibroblasts, alterations of morphological characteristics of corneal fibroblasts, increased susceptibility to intracellular oxidative stress, dysfunctional and fragmented mitochondria, defective autophagy, and alterations of cell cycle were observed. Other studies of mutated TGFBIp show changes in conformational structure, stability and proteolytic properties in lattice and granular corneal dystrophies. Future research should be directed toward elucidation of the biochemical mechanism of deposit formation, the relationship between the mutated TGFBIp and the other materials in the extracellular matrix, and the development of gene therapy and pharmaceutical agents.
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Visual Function and Higher-Order Aberrations in Eyes After Corneal Transplantation. Cornea 2015; 34 Suppl 11:S128-35. [DOI: 10.1097/ico.0000000000000589] [Citation(s) in RCA: 19] [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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Long-Term Dehydrated Donor Lamella Survival in Anterior Keratoplasty: Keratocyte Migration and Repopulation of Corneal Stroma. Cornea 2015; 34:1044-51. [PMID: 26186373 DOI: 10.1097/ico.0000000000000536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the ability of host keratocytes to colonize the donor lamella transplanted without viable cells (dehydrated) in Descemetic (deep anterior lamellar keratoplasty) and in pre-Descemetic keratoplasty (excimer laser-assisted lamellar keratoplasty). METHOD A total of 17 eyes (8 deep anterior lamellar keratoplasties and 9 excimer laser-assisted lamellar keratoplasties) were included in this observational retrospective study; patients underwent ophthalmic examinations, and histological staining was performed ex vivo on the graft in cases of failure. RESULTS In Descemetic keratoplasty, the long-term survival of the graft is compromised with the central corneal thickness decreasing; corneal pachymetry and in vivo and ex vivo keratocyte densities are significantly reduced (pachymetric reduction of -86 μm in the apex and -87 μm in the thinnest point; density cell reduction of 72% at a depth of 100 μm, 62% at a depth of 250 μm, and -66% at a depth of 400 μm). In pre-Descemetic keratoplasty, clinical complications, reduction of central thickness, or alterations of keratocyte density were not observed. CONCLUSIONS In Descemetic keratoplasty, the migration of the host peripheral keratocytes does not seem enough to repopulate the donor graft, whereas in pre-Descemetic keratoplasty, long-term survival of the graft is good. Keratocyte repopulation was observed only by extensive contact between the donor and host parenchyma.
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Corneal Regeneration by Deep Anterior Lamellar Keratoplasty (DALK) Using Decellularized Corneal Matrix. PLoS One 2015; 10:e0131989. [PMID: 26161854 PMCID: PMC4498638 DOI: 10.1371/journal.pone.0131989] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study is to demonstrate the feasibility of DALK using a decellularized corneal matrix obtained by HHP methodology. Porcine corneas were hydrostatically pressurized at 980 MPa at 10°C for 10 minutes to destroy the cells, followed by washing with EGM-2 medium to remove the cell debris. The HHP-treated corneas were stained with H-E to assess the efficacy of decellularization. The decellularized corneal matrix of 300 μm thickness and 6.0 mm diameter was transplanted onto a 6.0 mm diameter keratectomy wound. The time course of regeneration on the decellularized corneal matrix was evaluated by haze grading score, fluorescein staining, and immunohistochemistry. H-E staining revealed that no cell nuclei were observed in the decellularized corneal matrix. The decellularized corneal matrices were opaque immediately after transplantation, but became completely transparent after 4 months. Fluorescein staining revealed that initial migration of epithelial cells over the grafts was slow, taking 3 months to completely cover the implant. Histological sections revealed that the implanted decellularized corneal matrix was completely integrated with the receptive rabbit cornea, and keratocytes infiltrated into the decellularized corneal matrix 6 months after transplantation. No inflammatory cells such as macrophages, or neovascularization, were observed during the implantation period. The decellularized corneal matrix improved corneal transparency, and remodelled the graft after being transplanted, demonstrating that the matrix obtained by HHP was a useful graft for corneal tissue regeneration.
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Clinical outcomes and risk factors for graft failure after deep anterior lamellar keratoplasty and penetrating keratoplasty for macular corneal dystrophy. Cornea 2015; 34:171-6. [PMID: 25514701 DOI: 10.1097/ico.0000000000000327] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to compare visual acuity, clinical outcomes, complications, and risk factors for graft failure after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. METHODS Retrospective comparative case series. RESULTS The PK group consisted of 109 eyes of 84 patients and the DALK group consisted of 21 eyes of 20 patients. The mean logarithm of the minimum angle of resolution best-corrected visual acuity at 3 and 12 months was 0.5 versus 0.5 (P = 0.285) and 0.4 versus 0.4 (P = 0.67) in the DALK and PK groups, respectively. There was no significant statistical difference in astigmatism and spherical equivalent between the 2 groups at 12 months. In the PK group, graft rejection that was the most common cause of graft failure was seen in 27 eyes (25%), of which 55% occurred within 1 year. In the DALK group, Descemet membrane microperforation occurred in 5 eyes (24%) intraoperatively, and early postoperative Descemet membrane detachment with double anterior chamber occurred in 9 eyes (43%). Kaplan-Meier estimate of graft survival in PK versus DALK groups were 93% versus 80% at 1 year and 78% versus 70% at 4 years, respectively. CONCLUSIONS Visual and refractive outcomes are comparable between DALK and PK groups. DALK was superior to PK in its safety against postoperative complications such as endothelial rejection and secondary glaucoma. Graft failure in DALK was mostly associated with either intraoperative or early postoperative complications. DALK is a viable surgical option in cases with macular corneal dystrophy.
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Jung JW, Kim SA, Kang EM, Kim TI, Cho HS, Kim EK. Lattice corneal dystrophy type IIIA with hyaline component from a novel A620P mutation and distinct surgical treatments. Cornea 2015; 33:1324-31. [PMID: 25321938 DOI: 10.1097/ico.0000000000000281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to report a lattice corneal dystrophy (LCD) family with a novel mutation of A620P in the TGFBI gene, its long-term treatment, follow-up data, and related pathologic findings. METHODS A total of 28 family members were clinically examined, and blood samples or buccal epithelial cells were taken for DNA analysis. All exons from the entire TGFBI gene coding region were analyzed for mutations in 3 affected members. Exon 14 was amplified in other family members and in 100 normal Korean persons as control. Corneal tissues from 1 affected family member were examined using light and electron microscopy. RESULTS Clinical examination revealed relatively late-onset LCD with asymmetric progression and recurrent corneal erosion. The affected family members have been treated with penetrating keratoplasty, deep lamellar keratoplasty, and phototherapeutic keratectomy for up to 19 years. Screening of the TGFBI gene revealed a novel A620P mutation, which was found in all affected members. The amyloid origin of deposits was confirmed by Congo red and was also partially stained with Masson trichrome. Although there were no electron-dense bodies as in granular dystrophy, transmission electron microscopy demonstrated that the stromal deposits were not homogenous and contained a variety of constituents with different electron densities. CONCLUSIONS We present the characteristics and surgical treatment of corneas with a novel A620P mutation in TGFBI showing LCD type IIIA with hyaline component.
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Affiliation(s)
- Ji Won Jung
- *Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; †Department of Systems Biology, Yonsei University College of Life Science and Biotechnology, Seoul, Korea; and ‡Institute of Vision Research, Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Akanda ZZ, Naeem A, Russell E, Belrose J, Si FF, Hodge WG. Graft rejection rate and graft failure rate of penetrating keratoplasty (PKP) vs lamellar procedures: a systematic review. PLoS One 2015; 10:e0119934. [PMID: 25781319 PMCID: PMC4362756 DOI: 10.1371/journal.pone.0119934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of our investigation was to conduct a quantitative meta-analysis of the present world literature comparing the major surgical outcomes of penetrating keratoplasty (PKP) to lamellar procedures. Our goal is that clinicians, eye bank administrators, and health policy makers will be able to utilize this study in implementing decisions in regards to corneal transplantation. Methods Pooled measures of association were with odds ratios and because of study heterogeneity, the pooled effects were assumed to follow a random effects model (DerSimonian-Laird). The comparisons were between 1) PKP’s and all lamellar procedures (anterior AND posterior) and then 2) between PKP’s and all anterior lamellar procedures and 3) PKP and all posterior lamellar procedures. Results For PKP vs anterior lamellar procedures, the pooled odds ratio for rejection of PKP over lamellar keratoplasty (LK) was 3.56 (95% CI: 1.76-7.20) and for outright failure, the pooled odds ratio of PKP failure vs LK was 2.85 (95% CI: 0.84-9.66). For posterior lamellar procedures, the pooled odds ratio for rejection of PKP over LK was 1.52 (95% CI: 1.00-2.32). The pooled odds ratio for outright failure of PKP over posterior lamellar procedures was 2.09 (95% CI: 0.57-7.59). The follow up time was significantly longer for full transplants than for lamellar procedures. Conclusions For both anterior and posterior lamellar procedures, the odds ratios comparing rejection of full transplants to lamellar procedures (both anterior and posterior individually) were significantly higher in the PKP group. For outright failure, the PKP group also had a higher risk of failure than the lamellar groups but this was not statistically significant in either instance (anterior or posterior). Some of the clinical differences benefitting lamellar procedures may at least be partly explained by follow up time differences between groups and this needs to be accounted for more rigorously in future studies.
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Affiliation(s)
| | | | | | | | - Francie F. Si
- Western University, Ivey Eye Institute, London, Ontario, Canada
| | - William G. Hodge
- Western University, Ivey Eye Institute, London, Ontario, Canada
- * E-mail:
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Romano V, Iovieno A, Parente G, Soldani AM, Fontana L. Long-term clinical outcomes of deep anterior lamellar keratoplasty in patients with keratoconus. Am J Ophthalmol 2015; 159:505-11. [PMID: 25486540 DOI: 10.1016/j.ajo.2014.11.033] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/22/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To report long-term clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN Retrospective noncomparative interventional study. METHODS setting: Single center. patients: Total of 158 eyes/150 consecutive patients with keratoconus with postoperative follow-up time equal to or greater than 4 years. intervention: DALK. main outcome measure(s): Uncorrected and corrected distance visual acuity (UDVA, CDVA), mean refractive spherical equivalent (MRSE), keratometry, endothelial cell density (ECD). RESULTS Mean postoperative follow-up was 76.9 ± 23.2 (range 48-120) months. Preoperative UDVA was 20/400 (1.5 ± 0.4 logMAR), CDVA 20/50 (0.7 ± 0.2 logMAR), MRSE -11.1 ± 5.6 diopters (D), mean keratometry 60.7 ± 6.1 D, topographic astigmatism 4.7 ± 2.6 D. At last postoperative follow-up visit, UDVA improved to 20/50 (0.5 ± 0.3 logMAR), CDVA to 20/25 (0.09 ± 0.1 logMAR), MRSE to -2.6 ± 3.5 D, mean keratometry to 44.4 ± 2.2 D, and topographic astigmatism to 2.9 ± 1.3 D. Postoperative ECD did not vary from preoperative values being 2070.5 ± 367.5 cell/mm(2) and 2198 ± 373 cell/mm(2), respectively, with 70% of eyes (111/158) showing ECD ≥2000 cells/mm(2). Eighteen eyes (11.3 %) developed stromal or epithelial rejection, 3 (1.8%) required regrafting. Eyes with successful big bubble showed greater CDVA than those that required manual dissection at follow-up equal to or less than 5 years but comparable results in the longer term. CONCLUSIONS DALK provides stable long-term visual and refractive outcomes. Risk of graft rejection, postoperative complication, and late ECD decay is reduced when compared to standard penetrating keratoplasty.
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Affiliation(s)
- Vito Romano
- Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
| | - Alfonso Iovieno
- Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy
| | | | - Anna Maria Soldani
- Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy
| | - Luigi Fontana
- Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy
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Cano-Ortiz A, Villarrubia A. [Corneal transplantation in keratoconus: penetrating keratoplasty versus deep anterior lamellar keratoplasty with Melles technique]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:4-8. [PMID: 25443212 DOI: 10.1016/j.oftal.2014.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/15/2014] [Accepted: 07/30/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of deep anterior lamellar keratoplasty (DALK) using Melles technique (technique B) in patients with advanced keratoconus versus a classic technique, penetrating keratoplasty (technique A). METHODOLOGY Retrospective descriptive comparative study between technique A and technique B in homogeneous groups. RESULTS Best corrected visual acuity (Snellen test decimal scale) was 0.77±0.32 for group A and 0.62±0.29 for group B, with no statistically significant differences. The mean spherical final refraction in group A was 1.73±5.1 diopters, and the mean spherical equivalent was -3.92±5.1. Technique B group gave values -2.67±4.02 diopters and -4.55±4.08 diopters, respectively, with no statistically significant differences. The residual cylinder after removal of the sutures was 4.47±2.47 diopters for group A and 3.77±1.63 for group B, with no statistically significant differences. CONCLUSION No statistically significant differences were found for any of the studied variables when comparing both groups using the t -test for independent samples. More studies on the homogeneity and residual stromal bed thickness could provide the key to determine whether this technique is closer to the visual acuity of penetrating keratoplasty or DALK by a descemet technique.
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Affiliation(s)
- A Cano-Ortiz
- Sección Córnea, Superficie Ocular Y Refractiva, Hospital La Arruzafa, Córdoba, España
| | - A Villarrubia
- Sección Córnea, Superficie Ocular Y Refractiva, Hospital La Arruzafa, Córdoba, España.
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Lamm V, Hara H, Mammen A, Dhaliwal D, Cooper DK. Corneal blindness and xenotransplantation. Xenotransplantation 2014; 21:99-114. [PMID: 25268248 PMCID: PMC4181387 DOI: 10.1111/xen.12082] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/07/2013] [Indexed: 12/13/2022]
Abstract
Approximately 39 million people are blind worldwide, with an estimated 285 million visually impaired. The developing world shoulders 90% of the world's blindness, with 80% of causative diseases being preventable or treatable. Blindness has a major detrimental impact on the patient, community, and healthcare spending. Corneal diseases are significant causes of blindness, affecting at least 4 million people worldwide. The prevalence of corneal disease varies between parts of the world. Trachoma, for instance, is the second leading cause of blindness in Africa, after cataracts, but is rarely found today in developed nations. When preventive strategies have failed, corneal transplantation is the most effective treatment for advanced corneal disease. The major surgical techniques for corneal transplantation include penetrating keratoplasty (PK), anterior lamellar keratoplasty, and endothelial keratoplasty (EK). Indications for corneal transplantation vary between countries, with Fuchs' dystrophy being the leading indication in the USA and keratoconus in Australia. With the exception of the USA, where EK will soon overtake PK as the most common surgical procedure, PK is the overwhelming procedure of choice. Success using corneal grafts in developing nations, such as Nepal, demonstrates the feasibility of corneal transplantation on a global scale. The number of suitable corneas from deceased human donors that becomes available will never be sufficient, and so research into various alternatives, for example stem cells, amniotic membrane transplantation, synthetic and biosynthetic corneas, and xenotransplantation, is progressing. While each of these has potential, we suggest that xenotransplantation holds the greatest potential for a corneal replacement. With the increasing availability of genetically engineered pigs, pig corneas may alleviate the global shortage of corneas in the near future.
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Affiliation(s)
- Vladimir Lamm
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hidetaka Hara
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alex Mammen
- Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Deepinder Dhaliwal
- Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David K.C. Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lim L, Lim SWY. Donor cornea preparation in partial big bubble deep anterior lamellar keratoplasty. Clin Ophthalmol 2014; 8:363-7. [PMID: 24523576 PMCID: PMC3921025 DOI: 10.2147/opth.s52395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this paper is to describe a technique of donor cornea preparation to ensure good graft-host apposition in incomplete big bubble deep anterior lamellar keratoplasty. Methods Following a partial-thickness trephination, manual dissection and excision of corneal stroma was performed. Anwar’s big-bubble technique involving a deep stromal air injection was then initiated. However, the big bubble could not extend to the trephination edge and the peripheral residual corneal stroma could not be removed. Donor cornea preparation involving trimming of the posterior lip of the corneal button was then performed and good graft-host apposition was obtained without graft over-ride. Results We performed peripheral donor cornea trimming prior to allograft placement in order to ensure good graft-host apposition. Postoperatively, best-corrected visual acuity in both eyes was 6/7.5. Conclusion Donor cornea preparation involving trimming of the posterior lip of the corneal button is a useful technique in instances where the big bubble does not extend to the trephination edge and ensures good graft-host apposition.
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Affiliation(s)
- Li Lim
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
| | - Samuel Wen Yan Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Vajpayee RB, Maharana PK, Sharma N, Agarwal T, Jhanji V. Diamond knife–assisted deep anterior lamellar keratoplasty to manage keratoconus. J Cataract Refract Surg 2014; 40:276-82. [DOI: 10.1016/j.jcrs.2013.07.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/20/2013] [Accepted: 07/24/2013] [Indexed: 11/29/2022]
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Abstract
PURPOSE To assess the influence of donor characteristics on the outcome of anterior lamellar keratoplasty (ALK) and to evaluate whether corneal donor tissue considered unsuitable for penetrating or posterior lamellar keratoplasty due to poor endothelial condition may be safely used for ALK. METHODS Institutional setting. One hundred sixty-six consecutive ALK (166 patients) performed for optical indication in eyes with corneal diseases not involving the corneal endothelium. The main outcome measures were graft survival, early (0-12 months postoperatively) and late (after 12 months) annual endothelial cell loss, and postoperative logarithm of the minimum angle of resolution visual acuity. RESULTS The average and extreme values of donor tissue characteristics were: donor age, 70.6 years (range, 28-88 years); organ culture time, 20.9 days (range, 12-35 days); graft endothelial cell density before transplantation, 2047 cells per millimeters (range, 100-3300 cells/mm2); and deswelling time, 2.0 days (range, 1-4 days). The average follow-up time of patients was 48.1 ± 24.8 months (mean ± SD). None of the donor characteristics significantly influenced graft survival or postoperative endothelial cell loss (early and late phase). Donor age >80 years was associated with lower postoperative visual acuity at all postoperative points in time (P < 0.05). At 3 years, the mean logarithm of the minimum angle of resolution visual acuity was 0.44 (20/55) for grafts from donors older than 80 years and 0.25 (20/35) for younger donors. This result was shown to be significant both in univariate and in multivariate analysis. CONCLUSIONS Grafts from elderly donors should be discarded before ALK. Conversely, donor tissue with poor endothelial cell density (<2000 cells/mm2) is suitable for ALK.
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Refractive and visual outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty with hydrodissection for treatment of keratoconus. Cornea 2013; 32:e2-5. [PMID: 22929159 DOI: 10.1097/ico.0b013e31825ca70b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare refractive and visual outcomes of penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) with hydrodissection for keratoconus. METHODS A review of medical records was performed to identify 69 subjects (77 eyes) who had undergone keratoplasty by a single surgeon. Inclusion criteria were as follows: no episodes of rejection, no adverse events or complications intraoperatively or postoperatively, a fairly normal rate of epithelialization within 2 weeks, and suture removal after 11 months. Eyes were categorized according to the procedure: 47 had undergone DALK with hydrodissection (DALK group) and 30 had undergone PKP (PKP group). A between-group comparison was performed. RESULTS Before suture removal, there was no statistical difference between groups in best-corrected visual acuity (BCVA) or refraction at 6 months (P > 0.05, all cases). The mean BCVA was 0.18 logarithm of the minimum angle of resolution for both groups at 12 months (just after suture removal) and 24 months postoperatively. The mean postoperative mean refractive spherical equivalents at 12 months and 2 years were -4.11 ± 3.4 diopters (D) and -4.68 ± 2.9 D, respectively, for the DALK group and -1.7 ± 2.7 D and -1.1 ± 3.6 D, respectively, for the PKP group. The DALK group was statistically more myopic at 12 and 24 months (P > 0.05, both cases). The mean refractive cylinders at 12 months and 2 years were 2.88 ± 1.60 D and 3.18 ± 1.70 D, respectively, for the DALK group and 2.80 ± 1.6 D and 3.80 ± 1.80 D, respectively, for the PKP group. The differences between groups were not statistically significant (P > 0.05, all comparisons). CONCLUSIONS Long-term BCVA, mean refractive spherical equivalent, and mean refractive cylinder after DALK with hydrodissection were similar to those after PKP.
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A retrospective contralateral study comparing deep anterior lamellar keratoplasty with penetrating keratoplasty. Cornea 2013; 32:385-9. [PMID: 22580442 DOI: 10.1097/ico.0b013e318254be4e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was conducted to compare endothelial cell (EC) loss, visual outcomes, and complications after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in the contralateral eyes of the same patients. METHODS A retrospective cohort study was undertaken at the Samsung Medical Center, Seoul Korea. We reviewed the records of 8 patients (16 eyes) who underwent PK in one eye and DALK in the contralateral eye. The DALK procedures were performed according to the Anwar and Teichmann big-bubble technique. EC loss, visual acuity, refractive status, and complications were evaluated to compare these techniques. RESULTS EC density was significantly higher after DALK compared with PK (at 12 months: 2045.8 ± 664.8 vs. 1732.6 ± 793.2, P = 0.044; at 24 months: 1900.3 ± 352.2 vs. 1416.2 ± 456.1, P = 0.013). The mean postoperative refractive astigmatism was -3.46 ± 2.57 diopters in the DALK-operated eyes versus -3.38 ± 2.48 diopters in the PK-operated eyes (P = 0.780), and the mean postoperative best-corrected visual acuity was 0.14 and 0.13 logarithm of the minimum angle of resolution, respectively (P = 0.870). There were no significant differences in the uncorrected visual acuity, best-corrected visual acuity, and refractive error between the DALK-operated and PK-operated eyes throughout the follow-up period. Rejection episodes were reported in 2 PK-operated eyes. No graft failures occurred. CONCLUSIONS Over the 2-year follow-up after DALK, EC loss was significantly lower, whereas the visual outcomes were comparable with those of the PK-operated eyes. No endothelial rejection occurred in the DALK-operated eyes. DALK is an effective alternative surgical procedure for corneal stromal pathologies.
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The role of penetrating keratoplasty in the era of selective lamellar keratoplasty. Int Ophthalmol Clin 2013; 53:91-101. [PMID: 23470592 DOI: 10.1097/iio.0b013e31827823dd] [Citation(s) in RCA: 3] [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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Sogutlu Sarı E, Kubaloglu A, Unal M, Pınero D, Bulut N, Erol MK, Özertürk Y. Deep anterior lamellar keratoplasty versus penetrating keratoplasty for macular corneal dystrophy: a randomized trial. Am J Ophthalmol 2013; 156:267-274.e1. [PMID: 23622562 DOI: 10.1016/j.ajo.2013.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/06/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. DESIGN Prospective, randomized, interventional case series. METHODS setting: Single hospital. patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated. RESULTS The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P > .05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P > .05). Significantly higher levels of higher-order aberrations were found in the DALK group (P < .01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P < .01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P = .03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively. CONCLUSIONS Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement.
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Abstract
PURPOSE To report the perioperative complications and clinical outcomes after deep anterior lamellar keratoplasty (DALK) using the big bubble technique in eyes with stromal corneal dystrophies. PATIENTS AND METHODS Seventy-four eyes of 65 patients who underwent DALK for stromal corneal dystrophies were evaluated in this retrospective interventional case series study. Main outcome measures were intraoperative and postoperative complications, postoperative uncorrected visual acuity, best spectacle-corrected visual acuity, spherical equivalent refraction, and topographic astigmatism. RESULTS There were 44 eyes with macular corneal dystrophy, 18 eyes with lattice dystrophy, and 12 eyes with granular dystrophy. DALK was completed in 69 cases (94.6%). Descemet membrane microperforations occurred in 6 eyes (8.7%). The mean follow-up period was 43.5 ± 23.9 months, ranging from 12 to 96 months. Postoperative best spectacle-corrected visual acuity of 0.5 or better was present in 52 of 69 eyes (75.4%). There were 3 episodes of stromal graft rejection, which responded to topical therapy. Lattice dystrophy recurred in 6 eyes (35.3%). CONCLUSION DALK using the big bubble technique is an effective procedure in the treatment of patients with corneal stromal dystrophies. Recurrence of lattice dystrophy was relatively high.
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Deep anterior lamellar keratoplasty for the treatment of stromal corneal dystrophies. Cornea 2013; 32:e184-5. [PMID: 23676785 DOI: 10.1097/ico.0b013e318292a7d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enzyme-assisted deep anterior lamellar keratoplasty-a new method of lamellar dissection-a wetlab-based pilot study. Cornea 2013; 32:98-103. [PMID: 22467004 DOI: 10.1097/ico.0b013e31823f8f5d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the safety of a new technique of lamellar dissection, using enzymatic digestion of the corneal stroma and extracellular matrix. METHODS This was a wetlab-based pilot study of hyaluronidase and trypsin-assisted deep anterior lamellar keratoplasty (DALK) in cadaveric human corneal tissue. Enzyme-assisted DALK was performed on 17 tissues. These underwent histologic analysis using a pneumatic dissection specimen as control. Rates of perforation and Descemet membrane (DM) exposure were recorded by clinical observation and by optical coherence tomography in selected cases. Where possible, pre- and postsurgical endothelial cell counts were obtained via specular microscopy. Two tissues from the same donor were halved, with each half soaked in a different solution (Optisol, balanced salt solution, hyaluronidase, and trypsin) for 13.5 hours to observe maximal effect. RESULTS Successful exposure of DM was achieved in 8 specimens. In the remaining 9, manual dissection was possible to a residual depth of 25 to 90 μm where measured with optical coherence tomography. Three tissues had perforation of DM, all via manual maneuvers. No deleterious effects on residual host tissue were observed by light microscopy with no significant rates of endothelial cell loss in 8 tissues in which a predissection cell count was obtainable. The 2 enzymes had differing effects on soaked specimens that were reflected intraoperatively. CONCLUSION Preliminary results of this ex vivo study are encouraging that enzymolysis may represent an effective innovation in DALK surgery with an acceptable safety profile. Further studies are required to refine the technique and application of the enzymes in vivo.
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Hong J, Sun X, Xu J. Outcomes of deep anterior lamellar keratoplasty using the big-bubble technique in various corneal diseases. Am J Ophthalmol 2013; 155:405-6. [PMID: 23312442 DOI: 10.1016/j.ajo.2012.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/01/2012] [Indexed: 11/17/2022]
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