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Zhao Y, Du K, Peng R, Hong J. Outcomes of Donor Corneas of Different Thicknesses From Endothelial Keratoplasty in Deep Anterior Lamellar Keratoplasty for Keratoconus. Cornea 2024:00003226-990000000-00619. [PMID: 39010268 DOI: 10.1097/ico.0000000000003580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To evaluate the outcomes of divided residual donor corneas obtained from endothelial keratoplasty in keratoconus with deep anterior lamellar keratoplasty (DALK). METHODS In this retrospective, comparative, clinical study, 103 keratoconic eyes that underwent DALK were enrolled; 67 eyes received thin grafts from Descemet stripping automated endothelial keratoplasty, and 36 received thick grafts from Descemet membrane endothelial keratoplasty. Baseline and postoperative central corneal thickness (CCT), inferior corneal thickness, uncorrected distance visual acuity, corrected distance visual acuity, corneal astigmatism, mean keratometry, biomechanical properties, and complication rates were measured. RESULTS Six months after transplantation, the group receiving thin grafts had a CCT of only 455.1 ± 43.0 μm, whereas that of the group receiving thick grafts was 546.7 ± 44.2 μm. Both CCT and inferior corneal thickness in the thin group were significantly lower than those in the thick group (measured with Pentacam at 36 months, P < 0.001) and remained throughout the 5-year follow-up period. Both procedures had comparable postoperative logarithm of the minimum angle of resolution UDVAs, logarithm of the minimum angle of resolution corrected distance visual acuity, astigmatism, and mean keratometry values (36 months; P = 0.335, 0.286, 0.680, and 0.365, respectively). Corneal biomechanical analysis revealed that the thin group had a significantly higher stiffness parameter at the first applanation than the thick group at the 2-year follow-up (P = 0.036) while other parameters were equivalent. CONCLUSIONS The outcomes of keratoplasty with donor tissue are comparable regardless of the thickness of the graft, which suggests that transplantation with either type of the split corneal procedure for DALK in patients with keratoconus is feasible.
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Affiliation(s)
- Yinghan Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Kaiyue Du
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; and
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Weller JM, Hübner L, Kruse FE, Tourtas T. Characterisation of ectasia after penetrating keratoplasty in keratoconus eyes using anterior segment optical coherence tomography. Br J Ophthalmol 2024; 108:506-512. [PMID: 36941032 PMCID: PMC10958274 DOI: 10.1136/bjo-2022-322859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/02/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND/AIMS Ectasia of the cornea can occur decades after penetrating keratoplasty (PK), especially in keratoconus eyes. The purpose of this study was to characterise ectasia after PK by morphological findings in anterior segment optical coherence tomography (AS-OCT). METHODS In this retrospective, single-centre case series, 50 eyes of 32 patients with a history of PK at an average of 25±10 years earlier were included. The eyes were classified either as ectatic (n=35) or as non-ectatic (n=15). The main parameters included central corneal thickness (CCT), lowest corneal thickness at the interface (LCTI), anterior chamber depth, graft-host interface angle at the thinnest point and host cornea-iris angle. Furthermore, steep and flat keratometry readings obtained by AS-OCT (CASIA-2, Tomey) and Scheimpflug tomography (Pentacam, Oculus) were assessed. OCT findings were correlated with clinical grading of ectasia. RESULTS There was a highly significant difference in LCTI, graft-host interface angle and anterior chamber depth (in pseudophakic eyes) between the groups. The ratio calculated by the quotient of LCTI divided by CCT was significantly lower in ectatic than non-ectatic eyes (p<0.001). In eyes with an LCTI/CCT ratio of ≤0.7, the OR for the occurrence of a clinical detectable ectasia was 2.4 (CI 1.5 to 3.7). Steep keratometry values were significantly higher in ectatic eyes. CONCLUSION AS-OCT is a helpful tool to recognise and quantify ectasia in post-PK eyes objectively.
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Affiliation(s)
- Julia M Weller
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lisa Hübner
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich E Kruse
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Theofilos Tourtas
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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3
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Kapelushnik N, Avni-Zauberman N, Herber R, Berger Y, Ezra Nimni O, Abd-Elkader A, Raiskup F, Barequet IS. Corneal cross-linking for treatment of keratoconus relapse in post-keratoplasty eyes. Int Ophthalmol 2023; 43:4027-4034. [PMID: 37436552 DOI: 10.1007/s10792-023-02807-x] [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: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Keratoconus relapse after penetrating keratoplasty is a rare condition that may result in severe visual deterioration and corneal graft thinning. Therefore, treatment to stabilize the cornea should be considered. The purpose of this study was to evaluate the safety and efficacy of Corneal Cross-Linking (CXL) in eyes with relapse of keratoconus after penetrating keratoplasty for keratoconus. MATERIALS AND METHODS A retrospective review of eyes that developed keratoconus relapse following a penetrating keratoplasty and treated with CXL. The main outcome measures were change in maximal keratometry (Kmax), best-corrected distance visual acuity (BCVA), thinnest corneal thickness (TCT) and central corneal thickness (CCT), and complications. RESULTS We identified 10 consecutive eyes of 9 patients. Preoperative median BCVA before the CXL and 1 year after the CXL procedure remained stable (p = 0.68). The median (IQR) of Kmax improved from 63.2 (24.9) D before the CXL procedure to 62.2 (27.1) D at 1 year postoperatively (P = 0.028). Median TCT and CCT also remained with no significant change 1 year after CXL. No complications were noted following the procedure. CONCLUSION CXL in eyes with keratoconus relapse after keratoplasty is a safe and effective procedure enabling not only visual stabilization but also might bring keratometry improvement. Routine follow-up after keratoplasty should be performed for early detection of keratoconus relapse and CXL is timely advised when such a relapse is documented.
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Affiliation(s)
- Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Noa Avni-Zauberman
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Yoav Berger
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Orit Ezra Nimni
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Amir Abd-Elkader
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Law E, Moledina M, Sexton I, Myerscough J. High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses. Eye Contact Lens 2023; 49:417-421. [PMID: 37595277 DOI: 10.1097/icl.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES After penetrating keratoplasty (PK) for keratoconus, vision can be impaired by high-degree astigmatism, particularly in those patients with recurrent peripheral ectasia. Scleral contact lenses (CLs) have long been used in the management of keratoconus both in treatment-naive corneas and those postcorneal transplants. We report the use of miniscleral CLs and their related visual and clinical outcomes in a series of patients with post-PK peripheral rim ectasia. METHODS In this retrospective case series, 5 patients (7 eyes) presented because of reduced visual acuity with their spectacles/CLs and/or reduced comfort with their existing rigid gas-permeable lenses. All patients in this series underwent PK more than two decades ago for keratoconus (mean 28.7 years±7.2). All patients demonstrated characteristic thinning at the graft-host junction, with anterior chamber deepening. Central corneas had remained clear in all patients inferring high visual potential. Contact lenses used were No 7 Comfort 15 miniscleral and the Onefit MED scleral with 14.5 mm and 15.6 mm diameters, respectively. RESULTS All eyes achieved a best-corrected visual acuity of 6/9 or greater. One case had difficulty with insertion and removal and has since discontinued wearing lens at this time. All others are successfully wearing the lenses regularly. CONCLUSION Despite advances in CL design, surgical management is still required in some patients. Miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes before proceeding with repeat surgical intervention.
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Affiliation(s)
- Elizabeth Law
- Department of Ophthalmology (E.L., M.M., I.S., J.M.), Southend University Hospital, Southend-on-Sea, United Kingdom; and Faculty of Medicine and Dentistry (J.M.), University of Plymouth, Plymouth, United Kingdom
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Johns LK, Leon P, Cortes-Barrantes P, Hanbazazh M, Zurakowski D, Dryja TP, Ciolino JB. Recurrent keratoconus: an analysis of breaks in Bowman's layer in corneal grafts. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001225. [PMID: 37278429 DOI: 10.1136/bmjophth-2022-001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To study in a masked fashion whether an objective histological feature associated with keratoconus (KCN) occurs in donor corneas in eyes originally receiving a corneal graft for KCN. METHODS Two ocular pathologists performed a retrospective masked histological analysis of slides from donor buttons recovered from 21 eyes with a history of KCN undergoing repeat penetrating keratoplasty (failed-PK-KCN), 11 eyes that underwent their first PK due to KCN (primary KCN), and 11 eyes without history of KCN which underwent PK for other conditions (failed-PK-non-KCN). Breaks/gaps in Bowman's layer served as the pathological feature indicative of recurrent KCN. RESULTS Breaks in Bowman's layer were present in 18/21 (86%) of the failed-PK-KCN group, 10/11 (91%) of the primary KCN group, and in 3/11 (27%) of the failed-PK-non-KCN group. Pathological evidence suggests that the prevalence of breaks is significantly higher in grafted patients with a history of KCN than non-KCN controls (OR: 16.0, 95% CI 2.63 to 97.2, Fisher's exact test p=0.0018) with a conservative Bonferroni criterion of p <0.017 to account for multiple group comparisons. There was no statistically significant difference found between the failed-PK-KCN and primary KCN groups. CONCLUSIONS This study provides histological evidence that breaks and gaps in Bowman's layer, consistent with those found in primary KCN, may develop within the donor tissue in eyes with a history of KCN.
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Affiliation(s)
- Lynette K Johns
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Pia Leon
- Ospedale SS Giovanni e Paolo Venezia, Venezia, Italy
| | | | - Mehenaz Hanbazazh
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Pathology, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Thaddeus P Dryja
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Dockery PW, Parker JS, Birbal RS, Tong CM, Parker JS, Joubert KP, Melles GRJ. Clinical outcomes of Descemet membrane endothelial keratoplasty performed in eyes with keratoconus and corneal endothelial dysfunction. Eur J Ophthalmol 2023; 33:52-57. [PMID: 36112930 DOI: 10.1177/11206721221123902] [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: 01/11/2023]
Abstract
PURPOSE To evaluate the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with comorbid keratoconus (KCN) and corneal endothelial dysfunction. METHODS Twenty-five consecutive eyes of 14 patients with comorbid stable KCN underwent DMEK for corneal endothelial dysfunction; best spectacle corrected visual acuity (BSCVA), maximum corneal curvature (Kmax), maximum corneal power (Pmax), central corneal thickness (CCT), and intra- and postoperative complications were assessed. RESULTS Excluding eyes requiring re-transplantation for primary graft failure (n = 3), all eyes showed improvement in BSCVA, reaching ≥ 20/40 (0.5) in 86%, ≥ 20/25 (0.8) in 55%, and ≥ 20/20 (1.0) in 27% by one month postoperatively; 90%, 76%, and 48% by 6 months postoperatively; and 88%, 76%, and 47% by 12 months postoperatively. CCT decreased from 571μm preoperatively to 485μm at 1 month (p < 0.001) and 481μm at 12 months (p < 0.001). Kmax decreased by a median of 1.4 diopters (D) at 1 month (p = 0.003) and 3.1 D at 12 months (p = 0.021), and every eye with a preoperative Kmax ≥ 46 D demonstrated flattening. Pmax decreased by 2.1 D at 1 month (p = 0.001) and 4.0 D at 12 months (p = 0.016). CONCLUSION DMEK is technically feasible in eyes with comorbid KCN and may give excellent outcomes visual and refractive outcomes, including significant corneal flattening, which may potentially create a visually significant hyperopic shift in patients with severely ectatic corneas.
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Affiliation(s)
- Philip W Dockery
- Parker Cornea, Birmingham, AL, USA.,14523Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jack S Parker
- Parker Cornea, Birmingham, AL, USA.,Netherlands Institute for Innovative Ocular Surgery - USA (NIIOS-USA), San Diego, USA
| | - Rénuka S Birbal
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Amnitrans Eye Bank Rotterdam (AER), Rotterdam, The Netherlands.,Melles Cornea Clinic, Rotterdam, The Netherlands
| | - C Maya Tong
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Amnitrans Eye Bank Rotterdam (AER), Rotterdam, The Netherlands.,University of Alberta, Edmonton, Canada
| | | | | | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery - USA (NIIOS-USA), San Diego, USA.,Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Amnitrans Eye Bank Rotterdam (AER), Rotterdam, The Netherlands.,Melles Cornea Clinic, Rotterdam, The Netherlands
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Devebacak A, Degirmenci C, Barut Selver O, Palamar M, Egrilmez S. Correction of high astigmatism with toric intraocular lens in eyes with corneal transplant. Eur J Ophthalmol 2022; 33:11206721221123885. [PMID: 36046940 DOI: 10.1177/11206721221123885] [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: 11/16/2022]
Abstract
OBJECTIVES To evaluate the results of toric intraocular lens (IOL) implantation during cataract surgery in eyes with high regular astigmatism associated with prior penetrating keratoplasty (PK). METHODS A retrospective data analysis of patients with prior PK, who underwent uncomplicated cataract surgery with hydrophobic toric single piece IOL (EyeCryl Toric®, Biotech Vision Care, Luzern, Switzerland). RESULTS A total of 18 eyes of 18 patients were included in the study. The mean age was 53.4 ± 12.4 (25-70) years. The mean follow-up period was 15.5 (4-24) months. The mean best corrected visual acuity (BCVA) significantly increased from 1.36 ± 1.0 logMAR to 0.31 ± 0.17 logMAR (p < .001) pre- and post-operative 4 weeks, respectively. There was no significant change in mean BCVA during follow-up; mean BCVA was 0.32 ± 0.17 logMAR at the last visit. The mean pre-operative topographic astigmatism was 6.52 ± 1.80 diopters (D). The mean manifest refraction astigmatism was decreased from 6.55 ± 1.62 D to 2.80 ± 1.43 D (p˂0.001). The mean Surgically induced astigmatism (SIA) was 3.74 ± 0.77 D according to vector analysis. There was no patient with graft rejection or failure, the mean endothelial cell loss rate was 12.75 ± 3.76% (7-17%). There was no patient requiring IOL reposition. CONCLUSIONS Toric IOL implantation during cataract surgery provides an option to correct astigmatism in post-PK eyes with high regular astigmatism. When appropriate patients are selected it is a safe method to achieve significant improvements in visual acuity and astigmatism.
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Affiliation(s)
- Ali Devebacak
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | | | | | - Melis Palamar
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
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Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options. J Clin Med 2022; 11:jcm11102678. [PMID: 35628805 PMCID: PMC9147912 DOI: 10.3390/jcm11102678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We propose to review the frequency, risk factors for the development, and the surgical options for the correction of high irregular astigmatism due to late graft ectasia following penetrating keratoplasty (PK). RESULTS: Post-keratoplasty ectasia is characterized by increasing corneal steepening with myopic shift and high irregular astigmatism, developing years or decades after PK, mostly occurring in KC patients. Contact lenses may adequately improve the visual acuity; however, because these patients are often elderly and intolerant to hard contact lenses, ultimately a surgical correction is proposed to the patient. Compressive suture and corneal wedge resection may improve corneal astigmatism, but the outcomes are unpredictable and often temporary. For this reason, a larger PK graft is often proposed for surgical rehabilitation with the consequence of removing more of the recipient’s healthy endothelium and exposing the patient to a renewed immunogenic stimulus and short-term graft failure for endothelial decompensation. More recently, lamellar keratoplasty using various techniques has been proposed as an alternative to PK in order to maximize the visual outcomes and minimize the complications. CONCLUSIONS: Management of advanced corneal ectasia is a significant challenge for corneal surgeons. Many surgical approaches have been developed, so there is a large arsenal of surgical operations to correct post-PK ectasia. Among them, large-diameter anterior lamellar keratoplasty may be a viable, safer, and effective alternative to PK for the correction of post-keratoplasty ectasia.
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Abstract
PURPOSE To describe the risk factors, management, and outcome of delayed Descemet membrane (DM) detachment after penetrating keratoplasty (PK) for keratoconus. METHODS We report 7 eyes from 6 cases and combine these data with 7 previous case reports identified by a search of PubMed. RESULTS DM detachment occurred at a median of 25 years (range, 7-33 years) after PK. One individual had bilateral detachments. There was typically a mild ocular discomfort accompanied in some cases by a rapid onset of visual blur. Cases were often treated for allograft rejection before a DM detachment was suspected and confirmed by optical coherence tomography. Detachments were limited to the donor tissue in 11 eyes, but a DM break was identified at the time of onset in only 4 eyes. Thinning of the host corneal rim with ectasia was reported in 8 eyes (57%). In 3 eyes, the detachment resolved spontaneously, but in 2 eyes, a detachment was still present at 12 months. Gas tamponade to reattach the DM was performed in 9 eyes and was effective in 4 eyes. Five eyes underwent a repeat PK or endothelial keratoplasty. Histology showed fibroblastic proliferation on the stromal surface of the folded DM. CONCLUSIONS The cause for DM detachment many years after PK is unknown, although progressive thinning of the host cornea and secondary graft ectasia may be implicated. Gas tamponade can be effective, but a repeat keratoplasty might be necessary. DM detachment should be included in the differential diagnosis for late-onset corneal edema after PK.
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11
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Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus. Am J Ophthalmol 2020; 220:9-18. [PMID: 32681909 DOI: 10.1016/j.ajo.2020.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the 5-year outcomes of 9-mm-deep anterior lamellar keratoplasty (DALK) for keratoconus with those of conversions to mushroom keratoplasty (MK). DESIGN Retrospective cohort study. METHODS The setting was the Ospedali Privati Villa Igea, Department of Ophthalmology, Forlì, Italy. The study population consisted of the medical records of all attempted DALK procedures (416 eyes) for the indication of keratoconus performed between January 2012 and January 2018; 68 eyes (16.4%) were converted to MK and analyzed as a separate cohort. The mean follow-up time was 33.8 ± 15.1 months. Procedure(s) consisted of 9-mm DALK and MK (9-mm anterior lamella with 6-mm posterior lamella). Outcome measurements were best-corrected visual acuity (BCVA), refractive astigmatism, and endothelial cell loss (ECL) at 5 years. RESULTS Average BCVA at 5 years was 0.06 ± 0.07 in the DALK group and 0.09 ± 0.15 in the MK group (P = .88). Refractive astigmatism following suture removal (all visits later than 12 months) was slightly less in the DALK cohort (5-year DALK = 2.16 ± 1.40 diopter [D]; MK = 3.02 ± 0.89 D; P = .04; mean difference = 0.86 D [95% confidence interval [CI]: 0.71-1.01]). ECL was significantly higher in the MK group than in the DALK group at all follow-up intervals (5-year DALK = 19.36 ± 21.47%; MK = 56.61 ± 15.82%; P < .001). The total all-cause graft failure rate at 5 years was 0.58% for DALK (2 of 348) cases and 5.88% for MK (4 of 68) cases. CONCLUSIONS Excellent 5-year visual and clinical outcomes associated with a 2-piece MK in cases converted from intended DALK mandate large-diameter DALK (9 mm) as the optimal surgical approach to keratoconus.
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Peripheral Reconstructive Lamellar Keratoplasty for Late Ectasia After Penetrating Keratoplasty in Keratoconus Eyes. Cornea 2019; 38:1377-1381. [DOI: 10.1097/ico.0000000000002121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Uso de adhesivo tisular de fibrina en queratoplastia penetrante. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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Busin M, Madi S, Scorcia V, Santorum P, Nahum Y. A Two-Piece Microkeratome-Assisted Mushroom Keratoplasty Improves the Outcomes and Survival of Grafts Performed in Eyes with Diseased Stroma and Healthy Endothelium (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2015; 113:T1. [PMID: 26538771 PMCID: PMC4597759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To test the hypothesis that a new microkeratome-assisted penetrating keratoplasty (PK) technique employing transplantation of a two-piece mushroom-shaped graft may result in better visual outcomes and graft survival rates than those of conventional PK. METHODS Retrospective chart review of 96 eyes at low risk and 76 eyes at high risk for immunologic rejection (all with full-thickness central corneal opacity and otherwise healthy endothelium) undergoing mushroom PK between 2004 and 2012 at our Institution. Outcome measures were best-corrected visual acuity (BCVA), refraction, corneal topography, endothelial cell density, graft rejection, and survival probability. RESULTS Five years postoperatively, BCVA of 20/40 and 20/20 was recorded in 100% and over 50% of eyes, respectively. Mean spherical equivalent of refractive error did not vary significantly over a 5-year period; astigmatism averaged always below 4 diopters, with no statistically significant change over time, and was of the regular type in over 90% of eyes. Endothelial cell density decreased to about 40% of the eye bank count 2 years after mushroom PK and did not change significantly thereafter. Five years postoperatively, probabilities of graft immunologic rejection and graft survival were below 5% and above 95%, respectively. There was no statistically significant difference in endothelial cell loss, graft rejection, and survival probability between low-risk and high-risk subgroups. CONCLUSIONS Refractive and visual outcomes of mushroom PK compare favorably with those of conventional full-thickness keratoplasty. In eyes at high risk for immunologic rejection, mushroom PK provides a considerably higher probability of graft survival than conventional PK.
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Affiliation(s)
- Massimo Busin
- Department of Ophthalmology, "Villa Igea-Villa Serena" Private Hospitals, Forlì, Italy
| | - Silvana Madi
- Department of Ophthalmology, Alexandria University, Alexandria, Egypt
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | - Paolo Santorum
- Department of Ophthalmology, "San Maurizio" Central Regional Hospital, Bolzano, Italy
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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You J, Wen L, Roufas A, Madigan MC, Sutton G. Expression of SFRP Family Proteins in Human Keratoconus Corneas. PLoS One 2013; 8:e66770. [PMID: 23825088 PMCID: PMC3688946 DOI: 10.1371/journal.pone.0066770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/10/2013] [Indexed: 01/08/2023] Open
Abstract
We investigated the expression of the secreted frizzled-related proteins (SFRPs) in keratoconus (KC) and control corneas. KC buttons (∼8 mm diameter) (n = 15) and whole control corneas (n = 7) were fixed in 10% formalin or 2% paraformaldehyde and subsequently paraffin embedded and sectioned. Sections for histopathology were stained with hematoxylin and eosin, or Periodic Acid Schiff's reagent. A series of sections was also immunolabelled with SFRP 1 to 5 antibodies, visualised using immunofluorescence, and examined with a Zeiss LSM700 scanning laser confocal microscope. Semi-quantitative grading was used to compare SFRP immunostaining in KC and control corneas. Overall, KC corneas showed increased immunostaining for SFRP1 to 5, compared to controls. Corneal epithelium in all KC corneas displayed heterogeneous moderate to strong immunoreactivity for SFRP1 to 4, particularly in the basal epithelium adjacent to cone area. SFRP3 and 5 were localised to epithelial cell membranes in KC and control corneas, with increased SFRP3 cytoplasmic expression observed in KC. Strong stromal expression of SFRP5, including extracellular matrix, was seen in both KC and control corneas. In control corneas we observed differential expression of SFRP family proteins in the limbus compared to more central cornea. Taken together, our results support a role for SFRPs in maintaining a healthy cornea and in the pathogenesis of epithelial and anterior stromal disruption observed in KC.
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Affiliation(s)
- Jingjing You
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Li Wen
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Athena Roufas
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Michele C. Madigan
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
- School of Optometry & Vision Sciences, University of New South Wales, Kensington, New South Wales, Australia
- * E-mail:
| | - Gerard Sutton
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
- Auckland University, Auckland, New Zealand
- Vision Eye Institute, Chatswood, New South Wales, Australia
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Abstract
PURPOSE We analyzed the central corneal and graft-host junction (GHJ) thickness profiles in cases with signs of corneal ectasia after penetrating keratoplasty for keratoconus. METHODS Anterior segment optical coherence tomography (ASOCT) was performed in cases with clinical or topographic signs of ectasia after complete suture removal. Corneal thickness was measured on the GHJ and at 1 mm on either side of the GHJ. Corneal thickness maps using Scheimpflug imaging were obtained. RESULTS Eight patients (11 eyes) with an average age of 52.55 ± 10.13 years were included. Mean age of the corneal grafts was 25.83 ± 12.37 years. Mean central corneal thickness was 577.45 ± 78.52 (range, 486-704) μm. Mean thickness 1 mm inside the GHJ, at the GHJ, and 1 mm outside the GHJ was 511.81 ± 66.15 (range, 380-600), 438.18 ± 86.35 (range, 260-550), and 465.45 ± 110.93 (range, 320-690) μm, respectively. Thinning of the graft, GHJ, or the host cornea was seen on ASOCT in all eyes. The central graft thickness was significantly higher compared with the graft thickness at and around the GHJ (P < 0.05 for all). The inferonasal quadrant was the thinnest in 7 eyes (63.63%). CONCLUSIONS Corneal thinning beyond the GHJ and subsequent ectasia can occur many years after initial keratoplasty in cases with keratoconus. Long-term follow-up of these cases may be desirable after corneal transplantation surgery. ASOCT is a useful tool for monitoring corneal thickness at and around the GHJ.
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Böhringer D, Reinhard T. Long-term keratoplasty graft survival. Ophthalmology 2013; 120:216. [PMID: 23283193 DOI: 10.1016/j.ophtha.2012.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/17/2012] [Indexed: 11/28/2022] Open
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Baran I, Bradley JA, Alipour F, Rosenthal P, Le HG, Jacobs DS. PROSE treatment of corneal ectasia. Cont Lens Anterior Eye 2012; 35:222-7. [PMID: 22633003 DOI: 10.1016/j.clae.2012.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 01/01/2023]
Abstract
PURPOSE Prosthetic replacement of the ocular surface ecosystem (PROSE) uses custom designed and fabricated prosthetic devices in a treatment that restores vision, supports healing, reduces symptoms and improves quality of life in patients with complex corneal disease. We report the success rate for PROSE treatment of corneal ectasia. METHODS Records of 59 patients with corneal ectasia seen in consultation over 6 months were reviewed. Candidacy for treatment, topographic indices, change in visual acuity, achievement of satisfactory fit, device wear status and change in visual function at 6 months were recorded. RESULTS Sixteen eyes were non-candidates because conventional correction was adequate. Trial devices were inserted but not dispensed for 13 eyes. No eyes were excluded for severity of ectasia. In the remaining 89 eyes, satisfactory fit was achieved and a device was dispensed. Twenty-one eyes (15 patients) had undergone penetrating keratoplasty. Device wear at 6 months was documented in 78/89 eyes (88%). NEI VFQ-25 score improved 27.6 points (p<0.001) on a 100 point scale in patients wearing a device at 6 months. CONCLUSION All candidate eyes with corneal ectasia could be fitted with a PROSE device. PROSE treatment has a high success rate when measured by ability to achieve satisfactory fit, impact on visual acuity and 6 month data on both rate of continued wear and impact on visual function. PROSE treatment is an alternative to penetrating keratoplasty for patients with corneal ectasia who are contact lens intolerant.
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Affiliation(s)
- Inna Baran
- Boston Foundation for Sight, Needham, MA 02494, United States
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Sung MS, Oh HJ, Yoon KC. Changes in Higher-Order Aberrations after Penetrating Keratoplasty. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.8.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mi Sun Sung
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Han Jin Oh
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Yildiz EH, Cohen EJ, Virdi AS, Hammersmith KM, Laibson PR, Rapuano CJ. Quality of life in keratoconus patients after penetrating keratoplasty. Am J Ophthalmol 2010; 149:416-22.e1-2. [PMID: 20172068 DOI: 10.1016/j.ajo.2009.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/07/2009] [Accepted: 10/12/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine vision-related quality of life (QoL) measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) in keratoconus (KCN) patients who have undergone penetrating keratoplasty (PK) in 1 or both eyes and to compare the results of our study to those of historical controls. DESIGN Clinical-based, cross-sectional study. METHODS SETTING Wills Eye Institute, Cornea Service, Thomas Jefferson University, Philadelphia, Pennsylvania. STUDY POPULATION This study included 149 consecutive patients who had undergone PK for KCN. INTERVENTION Between June 1, 2008 and December 31, 2008, the NEI-VFQ was administered to 149 patients. The relationship between demographic and clinical factors and NEI-VFQ subscale scores was evaluated. MAIN OUTCOME MEASURE Vision-related quality of life. RESULTS Eighty-three of 149 patients (55.7%) were male. Approximately half of the patients (76/149; 51.0%) had PK in both eyes. Visual acuity with current correction in the better eye was better than 20/40 in 80% of patients (119/149). Our sample had significantly lower (worse) NEI-VFQ scores compared to Collaborative Longitudinal Evaluation of Keratoconus (CLEK) historical control group for the subscales of role difficulties, dependency, driving, and peripheral vision. In general, scores of our sample were between scores of patients with age-related macular degeneration (AMD) category 3 and 4. Patients with visual acuity better than 20/40 (in the better eye) showed significantly higher scores in all subscales except color vision. There was a significant relationship between minimum time since the graft of 5 years or greater and NEI-VFQ overall score better than AMD category 3 (P = .004). CONCLUSION Despite satisfactory results on visual outcome measures obtained after PK, vision-related QoL in KCN patients remains impaired.
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Affiliation(s)
- Elvin H Yildiz
- Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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