1
|
Koo EH. Current state of endothelial cell therapy. Curr Opin Ophthalmol 2024; 35:304-308. [PMID: 38602486 DOI: 10.1097/icu.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW Currently, there is heightened interest surrounding endothelial cell therapy for the treatment of corneal edema. The purpose of this review article is to describe and summarize the background information as well as the research surrounding the emerging treatment modalities for endothelial cell therapy. RECENT FINDINGS Marked advancements have been made in the translational research in this area, and increasing refinements have been demonstrated in the treatment protocols for cell therapy. Human clinical trials in this field are ongoing, specifically, in the area of injected human corneal endothelial cells (HCECs), with early results showing favorable safety and efficacy profiles. SUMMARY Efficient and effective delivery of HCECs to patients with corneal edema and dysfunction now appears feasible, and the results from ongoing human clinical trials are much anticipated. Adjunct therapeutics-in the form of pharmacological agents and/or surgical techniques, such as descemetorhexis-will likely continue to play an important role in defining the future of endothelial cell therapy.
Collapse
Affiliation(s)
- Ellen H Koo
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Zheng Q, Zheng Q, Chen W, Li J, Zhao Z, Wang H, Jiang D, Chen W. Repeat corneal transplantation in Southern China: Indications, surgical technique, outcomes, and risk factors for repeat keratoplasty failure. Indian J Ophthalmol 2024; 72:S482-S487. [PMID: 38648456 PMCID: PMC467028 DOI: 10.4103/ijo.ijo_3333_23] [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: 12/24/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To report the indications, surgical techniques, and outcomes of repeat keratoplasty and evaluate the risk factors for graft failure in the Chinese population. METHODS The medical records of 216 patients (243 cases) who underwent at least two keratoplasties at a leading eye hospital in southern China between 2011 and 2020 were retrospectively reviewed. Indications and surgical procedures for repeat corneal transplantation were analyzed. Kaplan-Meier survival analysis was used to determine the graft survival rate after repeat keratoplasty. A multivariable survival model was used to assess the risk factors. RESULTS Repeated keratoplasties increased continuously from 2011 to 2020 (P = 0.002). The most common primary indication was infectious keratitis (38.7%), and the most common reason for repeat keratoplasty was graft rejection (30.04%). Regraft techniques included penetrating keratoplasty (PK) in 165 cases (67.9%), deep lamellar keratoplasty (DALK) in 52 cases (21.40%), and endothelial keratoplasty (EK) in 26 cases (10.7%). Median survival was 5.3, 6.8, and 6.4 years for PK, DALK, and EK, respectively. The 5-year survival rate was 53.5%, 66.6%, and 69.8% for PK, DALK, and EK, respectively. The median LogMAR visual acuity was 1.4 for PK, 0.75 for DALK, and 1.2 for EK at the end of the follow-up. Multivariate analysis revealed that graft rejection is a risk factor for repeat keratoplasty failure (P = 0.002). CONCLUSIONS DALK and EK may provide better outcomes than PK in treating graft failure. Preventing and treating postoperative graft rejection may be key to improving regraft survival. These findings will aid in the management of failed corneal grafts.
Collapse
Affiliation(s)
- Qiaolan Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qinxiang Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wuhe Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jinyang Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zelin Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Haiou Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dan Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
3
|
Ali M, Dun C, Cho K, Soiberman U, Woreta F, Makary MA, Jhanji V, Srikumaran D. Infectious Keratitis After Keratoplasty in the United States: Analysis of a National Medicare Claims Data Set. Cornea 2024; 43:452-458. [PMID: 37903336 DOI: 10.1097/ico.0000000000003405] [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: 04/15/2023] [Accepted: 08/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE The aim of this study was to assess the incidence, trends, and risk factors of infectious keratitis (IK) and subsequent repeat keratoplasty after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). METHODS Using a retrospective cohort study design, IK cases within 6 months of keratoplasty were identified using billing codes among 100% Medicare beneficiaries aged 65 years and older who underwent either PK or EK between 2011 and 2020. Multivariable logistic regression models were used to evaluate factors associated with postkeratoplasty IK. RESULTS We identified 115,588 keratoplasties, of which 20.0% (n = 23,144) were PK and 80.0% (n = 92,444) were EK. IK developed within 6 months with a rate of 3.32% (n = 769) post-PK and 0.72% (n = 666) post-EK. Overall rates of IK decreased from 16.05 to 9.61 per 1000 keratoplasties between 2011 and 2020 ( P < 0.001). The median interval between keratoplasty and diagnosis of IK was 73 days (interquartile range: 29-114 days) for PK and 74 days (interquartile range: 38-116 days) for EK. After IK, 22.9% (n = 176) and 23.8% (n = 159) eyes underwent repeat keratoplasty within 1 year for PK and EK, respectively. The occurrence of IK after PK was associated with age 85 years and older [odds ratio (OR): 1.38; 95% confidence interval (CI): 1.13-1.68] relative to patients aged 65 to 74 years. The occurrence of IK after EK was also associated with age 85 years and older (OR: 1.44; 95% CI: 1.14-1.82) relative to patients aged 65 to 74 years. CONCLUSIONS IK was 4 times more common after PK than EK and the complication was associated with older age. Our findings may help corneal surgeons in counseling patients at higher risk and guiding their postoperative care.
Collapse
Affiliation(s)
| | - Chen Dun
- Departments of Surgery and
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, MD; and
| | | | | | | | | | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | |
Collapse
|
4
|
Huh DD, Dun C, Fliotsos MJ, Jeng BH, Stoeger CG, Makary M, Woreta FA, Wolle M, Srikumaran D. Trends and Surgeon Variations in Early Regrafts After Endothelial Keratoplasty: Analysis of the National Medicare Data Set. Cornea 2023; 42:1016-1026. [PMID: 36853597 DOI: 10.1097/ico.0000000000003252] [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: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The aims of this study were to determine national-level trends in early regraft rates and examine patient-level and surgeon-level characteristics associated with early regrafts. METHODS This was a retrospective, cohort study. We identified beneficiaries aged 65 years or older in the 2011 to 2020 Medicare carrier claims data set who underwent Endothelial keratoplasty (EK) and subsequently underwent an early regraft. The incidence of early regraft for each year was calculated and patient-level and surgeon-level characteristics associated with regrafts were examined using a multivariable regression model. RESULTS Of 114,383 EK procedures, 4119 (3.60%) were followed by an early regraft, with no significant variations in the rates between years ( P = 0.59). Factors associated with higher odds of early regraft were Black compared with White race (OR 1.151; 95% confidence interval (CI) 1.018-1.302) and the highest quartile of income versus the lowest quartile (OR 1.120; 95% CI 1.002-1.252). Factors associated with lower odds were female sex (OR 0.889; 95% CI 0.840-0.942), receiving surgery in a hospital-based outpatient department versus an ambulatory center (OR 0.813; 95% CI 0.740-0.894), and having a surgeon with the highest quartile of annual EK volume versus the lowest (OR 0.726; 95% CI 0.545-0.967). Early regraft rates among surgeons ranged from 0% to 58.8% with a median [interquartile range] of 3.13 [0-6.15]. CONCLUSIONS We found no significant increases in the early regraft rates over the past decade in the United States. Patient male sex and Black race, ambulatory surgery center-based location of the surgery, and low surgeon EK volume were associated with early regrafts. Substantial surgeon variability in regraft rates may indicate opportunities for improvement through development of best practices on perioperative management and patient counseling.
Collapse
Affiliation(s)
- Dana D Huh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Fliotsos
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bennie H Jeng
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika A Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meraf Wolle
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
5
|
Hicks PM, Armstrong ML, Woodward MA. Current social determinants of health and social risk factors in conditions of the cornea: a scoping review. Curr Opin Ophthalmol 2023; 34:324-333. [PMID: 37097186 PMCID: PMC10247394 DOI: 10.1097/icu.0000000000000960] [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] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW To achieve health equity in eye health and vision care, social determinants of health (SDoH) and the associated social risk factors must be addressed. To address SDoH and social risk factors in ophthalmology, they must first be identified. The purpose of this review was to determine the SDoH and social risk factors in conditions of the cornea that have most recently been explored. RECENT FINDINGS This review identified social risk factors associated with all five domains of SDoH, as outlined by Healthy People 2030. The neighborhood and built environment was the domain identified the most for both exploration and observation. The social and community context domain was the least explored, and healthcare access and quality and social and community context domains were the least observed. The cornea condition explored the most in relation to SDoH was dry eye syndrome. SUMMARY The findings from this review can inform clinicians on the social risk factors that could be screened for in eye care facilities, so patients can be connected with services to minimize the impact of social risk factors on cornea conditions. Furthermore, the findings have identified cornea conditions and domains of SDoH that are understudied which can be an area for future studies by vision researchers.
Collapse
Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Ali M, Cho K, Srikumaran D. Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment. Ophthalmol Ther 2023; 12:691-704. [PMID: 36637659 PMCID: PMC10011243 DOI: 10.1007/s40123-022-00637-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemet's membrane known as corneal guttae. Descemet membrane endothelial keratoplasty (DMEK) has evolved to become the standard of care for patients with FECD with excellent visual acuity outcomes. Patients with FECD may have coexisting cataracts and therefore may require a cataract surgery, which increases the risk of corneal decompensation. The presence of FECD may not only influence the choice of intraocular lens but vision outcomes can also be affected by the corneal condition. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. This review provides a guide for corneal surgeons in choosing between endothelial keratoplasty and cataract surgery-alone, in combination or sequential-in their management of patients with FECD.
Collapse
Affiliation(s)
- Muhammad Ali
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Kyongjin Cho
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Divya Srikumaran
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
7
|
Shah PP, Hasan A, Winokur J, Braunstein R, Ritterband DC, Seedor JA, Cheela I. Impact of Donor, Recipient, and Graft Characteristics on Corneal Transplantation Outcomes. Clin Ophthalmol 2023; 17:633-640. [PMID: 36866241 PMCID: PMC9970880 DOI: 10.2147/opth.s399847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose Although several donor, recipient, and graft characteristics have been studied in relation to corneal transplantation outcomes, no study to our knowledge has assessed the impact of donor cooling times on postoperative outcomes longitudinally. With only one corneal graft available for every 70 needed worldwide, this study seeks to identify any factors that could alleviate this shortage. Methods Patients undergoing corneal transplantation at the Manhattan Eye, Ear & Throat Hospital over a 2-year period were retrospectively studied. Study metrics included age, diabetic history, hypertensive history, endothelial cell density, death-to-preservation time (DTP), death-to-cooling time (DTC), and time-in-preservation (TIP). Postoperative transplantation outcomes, including best corrected visual acuity (BCVA) at 6- and 12-month follow-up visits, need for re-bubbling, and need for re-grafting, were assessed. Unadjusted univariate and adjusted multivariate binary logistic regressions were performed to determine the association of cooling and preservation parameters with corneal transplantation outcomes. Results Among 111 transplants, our adjusted model found that DTC ≥4 hours was associated with significantly worse BCVA, but only at 6-month postoperative follow-up (odds ratio [OR]: 0.234; 95% confidence interval [CI]: 0.073-0.747; p = 0.014). By 12-month follow-up, DTC >4 hours was no longer associated with BCVA in a statistically significant manner (OR: 0.472; 95% CI: 0.135-1.653; p = 0.240). A similar trend was found at a DTC cutoff of ≥3 hours. None of the other studied parameters, including DTP, TIP, donor age, or medical history were significantly correlated with transplantation outcomes. Conclusion Longer DTC or DTP did not have a statistically significant effect on corneal graft outcomes after one year, though short-term outcomes were improved in donor tissues with DTC below four hours. None of the other studied variables correlated with transplantation outcomes. Given the global shortage of corneal tissue, these findings should be considered when determining suitability for transplantation.
Collapse
Affiliation(s)
- Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Correspondence: Paras P Shah, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA, Email
| | - Aisha Hasan
- Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Jules Winokur
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Richard Braunstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - David C Ritterband
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - John A Seedor
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Isha Cheela
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| |
Collapse
|
8
|
Heckenlaible NJ, Dun C, Prescott C, Eghrari AO, Woreta F, Makary MA, Srikumaran D. Predictors of Receiving Keratoplasty for Fuchs' Endothelial Corneal Dystrophy among Medicare Beneficiaries. Ophthalmology 2023; 130:28-38. [PMID: 35932840 DOI: 10.1016/j.ophtha.2022.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To identify factors associated with receipt of endothelial keratoplasty (EK) and penetrating keratoplasty (PK) in patients with Fuchs' endothelial corneal dystrophy (FECD). DESIGN Retrospective cohort study. PARTICIPANTS Medicare beneficiaries 65 years of age or older with a FECD diagnosis between 2011 and 2019. METHODS The 100% Medicare fee-for-service administrative claims database was queried for treatment-naïve FECD patients. A multivariate logistic regression model including age, race and ethnicity, sex, geography, ocular comorbidities and surgeries, Charlson comorbidity index (CCI), and socioeconomic status was used to identify factors associated with receipt of EK and PK. Kaplan-Meier survival analyses were used to determine the rate of EK after cataract or complex or other anterior segment surgery. MAIN OUTCOME MEASURES Factors associated with receipt of an EK or PK, plus rate of EK after cataract or complex or other anterior segment surgery. RESULTS Of 719 066 beneficiaries identified, 31 372 (4.4%) received an EK and 2426 (0.3%) received a PK. In a multivariate analysis, female sex decreased likelihood of both EK and PK (adjusted odds ratio 0.83 [95% confidence interval 0.81-0.85] and 0.84 [0.78-0.92], respectively), while Western residence (1.33 [1.29-1.38]; 1.25 [1.11-1.42]) compared to Southern and history of complex or other anterior segment surgery (1.62 [1.54-1.70]; 5.52 [4.97-6.12]) increased the likelihood of both. Compared to Whites, the likelihood of EK was decreased for Black (0.76 [0.72-0.80]), Asian or Pacific Islander (0.54 [0.48-0.61]), and Hispanic or Latino (0.62 [0.55-0.70]) race and ethnicity, while for the same groups likelihood of PK was increased (for Black 1.32 [1.14-1.53]; Asian/Pacific Islander 1.46 [1.13-1.89]; and Hispanic/Latino 1.62 [1.25-2.11]). Following cataract or complex/other anterior segment surgery, rates of EK were 1.3% and 3.3% at 1 year and 2.3% and 5.6% at 8 years, respectively. CONCLUSIONS In a multivariate analysis, women beneficiaries are less likely to receive EK or PK for FECD compared with men, whereas non-White beneficiaries are less likely to receive EK and more likely to receive PK compared with White beneficiaries.
Collapse
Affiliation(s)
- Nicolas J Heckenlaible
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christina Prescott
- NYU Langone Eye Center, NYU Grossman School of Medicine, New York, New York
| | - Allen O Eghrari
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - Divya Srikumaran
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|