1
|
Price MO, Kanapka L, Kollman C, Lass JH, Price FW. Descemet Membrane Endothelial Keratoplasty: 10-Year Cell Loss and Failure Rate Compared With Descemet Stripping Endothelial Keratoplasty and Penetrating Keratoplasty. Cornea 2024; 43:1403-1409. [PMID: 38128100 DOI: 10.1097/ico.0000000000003446] [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: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The aim of this study was to assess long-term endothelial cell loss (ECL) and graft failure with Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) versus penetrating keratoplasty (PK) performed for the same indications (primarily Fuchs dystrophy and pseudophakic corneal edema) in the Cornea Donor Study. METHODS This retrospective study included consecutive primary DMEK (529 recipients, 739 eyes) and DSEK cases (585 recipients, 748 eyes) with 1 or more endothelial cell density (ECD) measurements at 6 months to 16 years. Main outcomes were ECD, longitudinal ECL, and graft failure. RESULTS Between 6 months and 8 years the ECD declined linearly by approximately 118 cells/mm 2 /yr after DMEK and 112 cells/mm 2 /yr after DSEK. Beyond 8 years postoperatively the rate of decline slowed substantially. Selective dropout from graft failure did not significantly affect the ECD trend. At 10 years, median ECL (interquartile range) was 63% (45, 73) with DMEK, 68% (48, 78) with DSEK, and 76% (70, 82) with PK ( P = 0.01 DMEK vs. DSEK, P <0.001 DMEK vs. PK, and P < 0.001 DSEK vs. PK). The proportion of surviving grafts with 10-year ECD <500 cells/mm 2 was 1.4% with DMEK, 7.3% with DSEK, and 23.9% with PK. The cumulative risk of graft failure between 6 months and 10 years was 5% with DMEK, 11% with DSEK, and 19% with PK ( P < 0.001). CONCLUSIONS Compared with PK and DSEK, DMEK had significantly lower ECL and significantly lower risk of secondary graft failure through 10 years.
Collapse
Affiliation(s)
| | | | | | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH; and
| | | |
Collapse
|
2
|
Van Meter WS. Are For-Profit Eye Banks a Good Idea? Cornea 2024; 43:1203-1206. [PMID: 38959421 DOI: 10.1097/ico.0000000000003566] [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: 08/12/2023] [Accepted: 03/28/2024] [Indexed: 07/05/2024]
Abstract
ABSTRACT For-profit eye banks have been advocated because they stimulate innovation and improve the quantity and quality of corneal tissue. The claims of for-profit eye banks do not stand up to scrutiny and promote discord in the recovery and distribution field. Commercialization can adversely affect public perception of corneal donation.
Collapse
Affiliation(s)
- Woodford S Van Meter
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY
| |
Collapse
|
3
|
Prada AM, Quintero F, Mendoza K, Galvis V, Tello A, Romero LA, Marrugo AG. Assessing Fuchs Corneal Endothelial Dystrophy Using Artificial Intelligence-Derived Morphometric Parameters From Specular Microscopy Images. Cornea 2024; 43:1080-1087. [PMID: 38334475 PMCID: PMC11296282 DOI: 10.1097/ico.0000000000003460] [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: 07/19/2023] [Revised: 11/01/2023] [Accepted: 11/23/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of artificial intelligence-derived morphometric parameters in characterizing Fuchs corneal endothelial dystrophy (FECD) from specular microscopy images. METHODS This cross-sectional study recruited patients diagnosed with FECD, who underwent ophthalmologic evaluations, including slit-lamp examinations and corneal endothelial assessments using specular microscopy. The modified Krachmer grading scale was used for clinical FECD classification. The images were processed using a convolutional neural network for segmentation and morphometric parameter estimation, including effective endothelial cell density, guttae area ratio, coefficient of variation of size, and hexagonality. A mixed-effects model was used to assess relationships between the FECD clinical classification and measured parameters. RESULTS Of 52 patients (104 eyes) recruited, 76 eyes were analyzed because of the exclusion of 26 eyes for poor quality retroillumination photographs. The study revealed significant discrepancies between artificial intelligence-based and built-in microscope software cell density measurements (1322 ± 489 cells/mm 2 vs. 2216 ± 509 cells/mm 2 , P < 0.001). In the central region, guttae area ratio showed the strongest correlation with modified Krachmer grades (0.60, P < 0.001). In peripheral areas, only guttae area ratio in the inferior region exhibited a marginally significant positive correlation (0.29, P < 0.05). CONCLUSIONS This study confirms the utility of CNNs for precise FECD evaluation through specular microscopy. Guttae area ratio emerges as a compelling morphometric parameter aligning closely with modified Krachmer clinical grading. These findings set the stage for future large-scale studies, with potential applications in the assessment of irreversible corneal edema risk after phacoemulsification in FECD patients, as well as in monitoring novel FECD therapies.
Collapse
Affiliation(s)
- Angelica M. Prada
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Facultad de Salud, Universidad Autónoma de Bucaramanga UNAB, Bucaramanga, Colombia
| | - Fernando Quintero
- Facultad de Ingeniería, Universidad Tecnológica de Bolívar, Cartagena, Colombia
| | - Kevin Mendoza
- Facultad de Ingeniería, Universidad Tecnológica de Bolívar, Cartagena, Colombia
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Facultad de Salud, Universidad Autónoma de Bucaramanga UNAB, Bucaramanga, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Facultad de Salud, Universidad Autónoma de Bucaramanga UNAB, Bucaramanga, Colombia
- Facultad de Salud, Universidad Industrial de Santander UIS, Bucaramanga, Colombia; and
| | - Lenny A. Romero
- Facultad de Ciencias Básicas, Universidad Tecnológica de Bolívar, Cartagena, Colombia
| | - Andres G. Marrugo
- Facultad de Ingeniería, Universidad Tecnológica de Bolívar, Cartagena, Colombia
| |
Collapse
|
4
|
Greenwald MF, Sawant OB, Titus MS, Ballouz D, Hood CT, Mian SI. Suitability and Early Clinical Outcomes of Corneal Donor Tissue in the 76-80-Year-Old Age Group. Cornea 2024:00003226-990000000-00651. [PMID: 39116278 DOI: 10.1097/ico.0000000000003644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 06/23/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE There is a significant global shortage of corneal donor tissue suitable for keratoplasty. One simple strategy for addressing this shortage is to increase the upper age limit for acceptable tissue over the current customary upper limit of age 75. We describe a pilot study completed at one eye bank procuring, processing, and distributing keratoplasty tissue from donors aged 76 to 80 years. METHODS This is a retrospective case series of donor tissues aged 76 to 80 years in comparison with donor tissues aged 71 to 75 years. Standard tissue parameters were evaluated for all tissues, including tissue suitability, mean endothelial cell density (ECD), death-to-procurement time, and cause of death. For the older tissues, clinical outcomes through 3 months were obtained from each surgeon, including intraoperative and postoperative complications. RESULTS Corneal tissues from donors aged 76 to 80 years had a similar suitability rate (57%) when compared with donors aged 71 to 75 years (59%) (P = 0.635). Both groups had comparable ECDs (P = 0.097). Early clinical outcomes of corneal grafts from donors older than 76 years were favorable, with no early graft failure or significant concerns for clinical safety or efficacy. CONCLUSIONS Our findings suggest that corneal tissues aged 76 to 80 years can be safely and efficiently transplanted in the United States. While additional study is needed, our results strengthen the case that expanding the upper age limit for donor age has the potential to help meet the global shortage for suitable keratoplasty tissue.
Collapse
Affiliation(s)
- Miles F Greenwald
- Kansas University Eye Center, Kansas University Medical Center, Prairie Village, KS
| | - Onkar B Sawant
- Eversight, Ann Arbor, MI
- Center for Vision and Eye Banking Research, Cleveland, OH; and
| | | | - Dena Ballouz
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI
| | | | - Shahzad I Mian
- Eversight, Ann Arbor, MI
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI
| |
Collapse
|
5
|
Boroumand S, Rahmani M, Sigaroodi F, Ganjoury C, Parandakh A, Bonakdar A, Khani MM, Soleimani M. The landscape of clinical trials in corneal regeneration: A systematic review of tissue engineering approaches in corneal disease. J Biomed Mater Res B Appl Biomater 2024; 112:e35449. [PMID: 39032135 DOI: 10.1002/jbm.b.35449] [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: 11/20/2023] [Revised: 04/27/2024] [Accepted: 06/19/2024] [Indexed: 07/22/2024]
Abstract
The limited availability of a healthy donor cornea and the incidence of allograft failure led researchers to seek other corneal substitutes via tissue engineering. Exploring the trend of clinical trials of the cornea with the vision of tissue engineering provides an opportunity to reveal future potential corneal substitutes. The results of this clinical trial are beneficial for future study designs to overcome the limitations of current therapeutic approaches. In this study, registered clinical trials of bio-based approaches were reviewed for corneal regeneration on March 22, 2024. Among the 3955 registered trials for the cornea, 392 trials were included in this study, which categorized in three main bio-based scaffolds, stem cells, and bioactive macromolecules. In addition to the acellular cornea and human amniotic membrane, several bio-based materials have been introduced as corneal substrates such as collagen, fibrin, and agarose. However, some synthetic materials have been introduced in recent studies to improve the desired properties of bio-based scaffolds for corneal substitutes. Nevertheless, new insights into corneal regenerative medicine have recently emerged from cell sheets with autologous and allogeneic cell sources. In addition, the future perspective of corneal regeneration is described through a literature review of recent experimental models.
Collapse
Affiliation(s)
- Safieh Boroumand
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahya Rahmani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faraz Sigaroodi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camellia Ganjoury
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azim Parandakh
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Bonakdar
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Khani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soleimani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Alsubaie H, Alrubaian A, Ahmad K, Ahad MA. Risk factors for corneal graft rejection after penetrating keratoplasty for keratoconus. Int Ophthalmol 2024; 44:286. [PMID: 38935251 DOI: 10.1007/s10792-024-02955-8] [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: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 06/28/2024]
Abstract
PURPOSE To evaluate the association between donor-related factors and the risk of rejection in patients undergoing penetrating keratoplasty (PKP) for keratoconus. METHODS A retrospective review was performed of keratoconus patients with no corneal neovascularization who underwent PKP from November 2014 to December 2016 and completed at least two years of follow-up. Preoperative, donor, operative, and postoperative data were collected and analyzed to identify factors leading to corneal graft rejection. RESULTS A total of 201 eyes (of 201 patients) that underwent PKP for keratoconus were included. Of these, 22.9% (95% CI 17.6-29.2%) had an episode of graft rejection. The overall graft survival rate was 98.5%. Receipts with a history of corneal transplant in the fellow eye (IRR 1.69, 95% CI 1.01, 2.80; p = 0.044) and those with postoperative stromal neovascularization (IRR 2.51, 95% CI 1.49, 4.21; p = 0.001) had a significantly higher incidence of rejection than those without these features. In univariate analysis, death-to-surgery time and death-to-excision time (DET) showed a weak association with graft rejection (p 0.05 and 0.08 respectively); However, in the multivariable analysis, this significance was lost. Grafts with a death-to-excision time (DET) greater than 8 h had a 0.53X lower risk of rejection compared with grafts with DET within 8 h or less (p = 0.05). Rejection was higher in patients receiving grafts with a preservation time within 7 days or less compared with preservation time greater than 7 days (30.6% vs. 21.2%, respectively, p = 0.291). CONCLUSION In the multivariable analysis, none of the donor-related factors were significantly associated with graft rejection; however, short death-to-surgery time may be associated with rejection after PKP. Recipients with a history of PKP in the fellow eye and those who developed corneal neovascularization were also at increased risk of developing rejection after keratoplasty.
Collapse
Affiliation(s)
- Hamad Alsubaie
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Al Urubah Rd, 11462, Riyadh, Saudi Arabia
| | - Ahmad Alrubaian
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Al Urubah Rd, 11462, Riyadh, Saudi Arabia
- Department of Ophthalmology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Muhammad Ali Ahad
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Al Urubah Rd, 11462, Riyadh, Saudi Arabia.
| |
Collapse
|
7
|
Berger T, Seitz B, Flockerzi E, Suffo S, Flockerzi FA, Berger M, Szentmáry N, Daas L. Surgical management of complicated Descemet's membrane detachment in corneas without prior endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2024; 262:879-889. [PMID: 37682334 PMCID: PMC10907463 DOI: 10.1007/s00417-023-06231-w] [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: 02/22/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention. METHODS Retrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD. RESULTS Fourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months - 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet's membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes. CONCLUSION PKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.
Collapse
Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Fidelis A Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
8
|
Tumlinson AR, Calara JM, Azar DT, Adamis AP, Vavvas DG, Stewart JM. Feasibility demonstration of a device for vitreous liquid biopsy incidental to intravitreal injection. PLoS One 2024; 19:e0294526. [PMID: 38241211 PMCID: PMC10798501 DOI: 10.1371/journal.pone.0294526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE VitreoDx is an experimental device enabling push-button collection of a neat vitreous liquid biopsy incidental to an intravitreal injection. We explored the ability of the device to collect a sample usable for proteomic biomarker discovery and testing. DESIGN Pilot study using ex vivo human eyes. METHODS Non-vitrectomized, human eyes from nine donors 75-91 years of age were refrigerated in BSS and used within 5 days of death. Four VitreoDx devices fitted with 25G needles, and four staked needle insulin syringes with 30G needles, were inserted at equal intervals through the pars plana of each eye and held in place by a fixture. The sampling mode of each VitreoDx device was triggered to attempt to acquire a liquid biopsy up to 70 μL. The plunger of each insulin syringe was retracted to attempt to obtain a liquid biopsy with a maximum volume of 50 μL. Samples acquired with the VitreoDx were extracted to polypropylene cryovials, refrigerated to -80 ºC, and sent for offsite proteomic analysis by proximity extension assay with a focus on panels containing approved and pipelined drug targets for neovascular disease and inflammatory factors. RESULTS Of the attempted liquid biopsies with the novel 25G VitreoDx, 92% (66 of 72) resulted in successful acquisition (>25 μL) while 89% (64 of 72) attempted by a traditional 30G needle resulted in a successful acquisition. Sample volume sufficient for proteomics array analysis was acquired by the VitreoDx for every eye. Detectable protein was found for 151 of 166 unique proteins assayed in at least 25% of eyes sampled by VitreoDx. CONCLUSIONS The high acquisition rate achieved by the prototype was similar to that achieved in previous clinical studies where a standard syringe was used with a 25G needle to biopsy vitreous fluid directly prior to standard intravitreal injection. Successful aspiration rates were likewise high for 30G needles. Together, these suggest that it is possible to routinely acquire liquid vitreous biopsies from patients who typically receive intravitreal injections with an injection device using a standard size needle without a vitreous cutter. Protein analysis shows that proteins of interest survive the sampling mechanism and may have potential to direct care in the future.
Collapse
Affiliation(s)
- Alexandre R. Tumlinson
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Jennifer M. Calara
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Dimitri T. Azar
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
| | - Anthony P. Adamis
- Twenty / Twenty Therapeutics LLC, South San Francisco, California, United States of America
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Demetrios G. Vavvas
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| |
Collapse
|
9
|
Yu AC, Sollazzo A, Bovone C, Busin M. Large-diameter deep anterior lamellar keratoplasty: A narrative review. Taiwan J Ophthalmol 2024; 14:27-33. [PMID: 38654986 PMCID: PMC11034690 DOI: 10.4103/tjo.tjo-d-23-00161] [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: 10/23/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) involves the selective replacement of diseased corneal stroma while preserving healthy unaffected endothelium. While DALK has failed to gain widespread popularity, improved visual and refractive outcomes of large-diameter grafts, which patients directly perceive following suture removal, may represent a compelling reason to shift toward DALK. Since the unaffected host endothelium is retained, DALK offers the opportunity to use large-diameter grafts, which reliably achieves maximum visual potential without an increased risk of immune-mediated stromal rejection. In this narrative review, we evaluate the current evidence on large-diameter DALK including surgical technique and clinical outcomes.
Collapse
Affiliation(s)
- Angeli Christy Yu
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Andrea Sollazzo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Cristina Bovone
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Massimo Busin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| |
Collapse
|
10
|
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
|
11
|
Thanuja MY, Ranganath SH, Srinivas SP. Role of Oxidative Stress in the Disruption of the Endothelial Apical Junctional Complex During Corneal Cold Storage. J Ocul Pharmacol Ther 2022; 38:664-681. [PMID: 36255463 DOI: 10.1089/jop.2022.0082] [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: 01/05/2023] Open
Abstract
Purpose: To characterize the impact of corneal cold storage (CS) on the endothelial apical junctional complex (AJC). Methods: Porcine corneas were held in CS (4°C; 1-7 days) with Cornisol™ preservation medium supplemented with epothilone B (EpoB; microtubule stabilizer; 100 nM), SB-203580 (p38 mitogen-activated protein [MAP] kinase inhibitor; 20 μM), or antioxidants (quercetin, 100 μM; vitamin E, 1 mM; deferoxamine, an iron chelator, 10 mM). After CS termination, the damage to endothelial AJC was characterized by imaging perijunctional actomyosin ring (PAMR) and zonula occludens (ZO-1). The effects of EpoB and SB-203580 were characterized by imaging microtubules. The loss in the barrier function was assessed in cultured cells grown on biotin-coated gelatin by permeability to fluorescein isothiocyanate (FITC)-avidin. The accumulation of reactive oxygen species (ROS), altered mitochondrial membrane potential (MMP), lipid peroxidation, and lactate dehydrogenase (LDH) release were also determined in response to CS. Results: CS led to the loss of microtubules, destruction of PAMR, and breakdown of ZO-1 in the endothelium. The severity of damage increased when CS was prolonged. Although rewarming of the tissue increased the damage, the effect was marginal. CS also induced accumulation of ROS, alteration in MMP, lipid peroxidation, enhanced LDH release, and increased permeability to FITC-avidin. These changes were opposed by EpoB, SB-203580, and antioxidants. Conclusion: Corneal CS destroys AJC of the endothelium, leading to loss of its barrier function. The effects were surmounted by microtubule stabilization, p38 MAP kinase inhibition, and antioxidants. Thus, there is potential for reformulation of the preservation medium to maintain the health of the donor corneal endothelium before transplantation.
Collapse
Affiliation(s)
- M Y Thanuja
- Bio-INvENT Lab, Department of Chemical Engineering, Siddaganga Institute of Technology, Tumakuru, India
| | - Sudhir H Ranganath
- Bio-INvENT Lab, Department of Chemical Engineering, Siddaganga Institute of Technology, Tumakuru, India
| | | |
Collapse
|
12
|
Kitazawa K, Toda M, Ueno M, Uehara A, Sotozono C, Kinoshita S. The Biologic Character of Donor Corneal Endothelial Cells Influences Endothelial Cell Density Post Successful Corneal Transplantation. OPHTHALMOLOGY SCIENCE 2022; 3:100239. [PMID: 36846106 PMCID: PMC9944567 DOI: 10.1016/j.xops.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
Purpose Corneal endothelial cell density (ECD) gradually decreases after corneal transplantation by unknown biologic, biophysical, or immunologic mechanism. Our purpose was to assess the association between donor corneal endothelial cell (CEC) maturity in culture and postoperative endothelial cell loss (ECL) after successful corneal transplantation. Design Prospective cohort study. Participants This cohort study was conducted at Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. It included 68 patients with a 36-month follow-up period who had undergone successful Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty. Methods Human CECs (HCECs) from remaining peripheral donor corneas were cultured and evaluated for maturity by surface markers (CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Postoperative ECD was assessed according to the mature-differentiated HCEC contents: high-maturity group: > 70%, middle-maturity group: 10% to 70%, low-maturity group: < 10%. The successful rate of ECD maintained at 1500 cells/mm2 at 36 months postoperative was analyzed using the log-rank test. Main Outcome Measures Endothelial cell density and ECL at 36 months postoperative. Results The 68 included patients (mean [standard deviation] age 68.1 [13.6] years, 47.1% women, 52.9% DSAEK). The high, middle, and low-maturity groups included 17, 32, and 19 eyes, respectively. At 36 months postoperative, the mean (standard deviation) ECD significantly decreased to 911 (388) cells/mm2 by 66% in the low-maturity group, compared with 1604 (436) by 40% and 1424 (613) cells/mm2 by 50% in the high and middle-maturity groups (P < 0.001 and P = 0.007, respectively) and the low-maturity group significantly failed to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Additional ECD analysis for patients who underwent DSAEK alone displayed a significant failure to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Conclusions The high content of mature-differentiated HCECs expressed in culture by the donor peripheral cornea was coincident with low ECL, suggesting that a high-maturity CEC content predicts long-term graft survival. Understanding the molecular mechanism for maintaining HCEC maturity could elucidate the mechanism of ECL after corneal transplantation and aid in developing effective interventions. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
Collapse
Key Words
- BK, bullous keratopathy
- CEC, corneal endothelial cell
- Corneal endothelial cell density
- Corneal transplantation
- Cultured corneal endothelial cells
- DSAEK
- DSAEK, Descemet stripping automated endothelial keratoplasty
- ECD, endothelial cell density
- ECL, endothelial cell loss
- Endothelial cell loss
- FACS, fluorescence-activated cell sorting
- HCEC, human CEC
- P, passage
- PK, penetrating keratoplasty
- SD, standard deviation
Collapse
Affiliation(s)
- Koji Kitazawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Munetoyo Toda
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Asako Uehara
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Shigeru Kinoshita
- Baptist Eye Institute, Kyoto, Japan,Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Correspondence: Shigeru Kinoshita, MD, PhD, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
| |
Collapse
|
13
|
Downward L, Ahmed M, Hopkinson C, Romano V, Curnow E, Kaye SB. Endothelial failure and rejection in recipients of corneas from the same donor. BMJ Open Ophthalmol 2022; 7:bmjophth-2021-000965. [PMID: 36161852 PMCID: PMC9389126 DOI: 10.1136/bmjophth-2021-000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/08/2022] [Indexed: 11/12/2022] Open
Abstract
Objective To determine whether patients who receive corneas from the same donor have similar risks of endothelial failure and rejection. Methods and Analysis Patients with Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) who received their first corneal transplant between 1999 and 2016 were analysed. Patients receiving corneas from donors who donated both corneas for the same indication were defined as ‘paired’. Gray’s test was used to compare the cumulative incidence of endothelial failure and rejection within 5 years post-transplant for ‘paired’ and ‘unpaired’ groups. Cox regression models were fitted to determine whether there was an association between recorded donor characteristics (endothelial cell density (ECD), age and sex and endothelial graft failure and rejection. Results 10 838 patients were analysed of whom 1536 (14%) were paired. The unpaired group comprised 1837 (69%) recipients of single corneal donors and 7465 (69%) donors who donated both corneas for another indication. ECD was lower for unpaired single cornea donors (p<0.01). There was no significant difference in endothelial graft failure or rejection between paired and unpaired groups for FED (p=0.37, p=0.99) or PBK (p=0.88, p=0.28) nor for donor ECD, age, sex and paired donation after adjusting for transplant factors (across all models p>0.16 for ECD, p>0.32 for donor age, p>0.14 for sex match and p>0.17 for the donor effect). Conclusion The absence of a significant difference in graft outcome for corneal transplants for FED and PBK between paired and unpaired donors may reflect a homogeneous donor pool in the UK.
Collapse
Affiliation(s)
- Lewis Downward
- Statistics, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Mahmoud Ahmed
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | - Cathy Hopkinson
- Statistics, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Elinor Curnow
- Statistics, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Stephen B Kaye
- Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
14
|
Fliotsos MJ, Campbell JA, Li X, Engstrom MB, Stoeger CG, McClory C, Titus MS, Johnson P, Johnston KB, Fischer T, Brooks LK, Montoya MM, Glasser DB, Akpek EK, Srikumaran D. Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States. Cornea 2022; 41:833-839. [PMID: 34369391 PMCID: PMC8818059 DOI: 10.1097/ico.0000000000002831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report trends in the prevalence of early graft failure after endothelial keratoplasty in the United States. METHODS Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft volumes were collected from records maintained by 6 major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures (defined as a graft with persistent edema or regrafted within 8 weeks after keratoplasty) each year were sourced from surgeon-reported adverse events. Failed graft cases from the 3 eye banks were compared with nonfailures at the donor and recipient levels to perform subset analysis of factors associated with early graft failure. RESULTS A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72% were DSAEK grafts. The total number of early graft failures reported was 168 of 14,284 (1.18%) for DMEK and 322 of 37,603 (0.86%) for DSAEK. Early DMEK failures decreased from 2013 (7.69%) to 2018 (0.68%). In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age, and diagnosis, an association of borderline significance was found between higher donor age and early failure [odds ratio (95% confidence interval): 1.03 (1.00-1.05); unit change of 1 yr] and DSAEK [odds ratio 1.02 (1.00-1.04); unit of change 1 yr] cases. CONCLUSIONS The proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. The surgical learning curve might have played a role.
Collapse
Affiliation(s)
- Michael J. Fliotsos
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jack A. Campbell
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - David B. Glasser
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esen Karamursel Akpek
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
15
|
Ghareeb AE, Figueiredo MS, Pradhan SP, Curnow E, Armitage WJ, Figueiredo FC. Long-Term Graft Survival and Decline in Endothelial Cell Density Following Penetrating Keratoplasty with Organ-Cultured Corneas. Ophthalmol Ther 2022; 11:1131-1146. [PMID: 35303284 PMCID: PMC9114181 DOI: 10.1007/s40123-022-00481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Endothelial cell density (ECD) changes long after penetrating keratoplasty (PKP) of organ-cultured corneas have been little studied. We aim to calculate the point when ECD decline stabilises following PKP with organ culture stored corneas. METHODS This is an observational study of first-ever PKPs and first-ever re-grafts, performed over 17 years under a single surgeon. ECDs were acquired at 3 and 6 months, 1 year post-graft and annually thereafter by specular microscopy. Time-dependent ECD data was fitted to a log-biexponential model. RESULTS We studied 465 first-ever grafts and 128 re-grafts. Mean recipient age was 59 years (range 0-96 years; SD 22). Median follow-up was 5.7 (range 0.2-17.1) years. Probability of ED at 5 years in first grafts and re-grafts was 4.4% (2.6-7.1%) and 14.8% (8.3-23.2%). In first grafts, ECD loss reached 0.6% per annum at 7.9 (6.2-9.6) years post-operatively. The half-lives of ECD loss during the immediate post-operative period for first grafts, re-grafts, dystrophies, ectasias, and previous ocular surgery are 20.1 (14.9-30.9), 12.8 (6.9-79.4), 19.5 (13.1-37.7), 26.2 (16.2-68), and 11.6 (6.7-41.3) months, respectively. The half-life during this rapid phase of ECD loss has an inverse correlation with graft survival at 10 years (r = - 0.89, p = 0.02). CONCLUSIONS Rate of endothelial decompensation is higher in first grafts than re-grafts. ECD decline stabilises 7.9 years post-operatively in first grafts but then becomes lower than the physiological loss expected. Further work is needed to verify whether organ-cultured grafts reach physiological levels of ECD loss faster than hypothermically stored grafts.
Collapse
Affiliation(s)
- Ali E Ghareeb
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK
- Department of Ophthalmology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Maria S Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Sayali P Pradhan
- Department of Ophthalmology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
| | | | - W John Armitage
- NHS Blood and Transplant, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Francisco C Figueiredo
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK.
- Department of Ophthalmology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK.
| |
Collapse
|
16
|
Risk factors of rejection after penetrating keratoplasty: a retrospective monocentric study. Graefes Arch Clin Exp Ophthalmol 2022; 260:3627-3638. [PMID: 35546638 DOI: 10.1007/s00417-022-05691-w] [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: 12/09/2021] [Revised: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess risk factors of rejection after penetrating keratoplasty (PKP). METHODS This retrospective monocentric study assessed risk factors for rejection in patients who underwent PKP at Montpellier University Hospital between June 2005 and September 2018. Graft and donor data were obtained from our tissue bank in Montpellier. Clinical data of recipients were recorded from medical files. Survival was estimated by the Kaplan-Meir method. Potential risk factors of rejection were assessed by multivariate Cox proportional hazards analysis, estimating hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Among the 316 consecutive patients (59% male, mean SD] age 52 [17]), 360 eyes underwent PKP. Indications for PKP were bullous keratopathy (27%), infectious keratitis (20%), and keratoconus (15%). The median follow-up was 44 months (IQR 22-73). The overall graft survival and irreversible rejection rate at 5 years were 70% and 29%, respectively. Factors associated with risk of rejection were prior indication for graft rejection (SHR [CI 95%] = 7.8 [2.6-23.1]), trauma (SHR [CI 95%] = 3.6 [1.1-11.7]), and infectious keratitis (SHR [CI 95%] = 2.7 [1.2-11.1]), history of corneal neovascularization (SHR [CI 95%] = 2.1 [1.2-3.8]), hypertonia (SHR [CI 95%] = 2.8 [1.8-4.3]), and mixed sex matching (SHR [CI 95%] = 2.0 [1.01-4.0]). CONCLUSION The significant risk factors of graft rejection after PKP found in this study agree with those from major international cohorts: prior indication for graft rejection, history of neovascularization and high intraocular pressure. Sex matching donor-recipient is a most recent parameter in the literature confirmed by the present analysis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04791696.
Collapse
|
17
|
The Cologne-Mecklenburg-Vorpommern DMEK Donor Study (COMEDOS) - design and review of the influence of donor characteristics on Descemet membrane endothelial keratoplasty (DMEK) outcome. Graefes Arch Clin Exp Ophthalmol 2022; 260:2417-2426. [PMID: 35294636 PMCID: PMC9325796 DOI: 10.1007/s00417-022-05594-w] [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: 08/24/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Posterior lamellar keratoplasty and especially Descemet membrane endothelial keratoplasty (DMEK) are gaining interest worldwide. Little is known about the influence of donor factors on DMEK outcome. Here we provide an overview of the existing peer-reviewed literature on this topic and present the design of the upcoming cooperation study COMEDOS (Cologne-Mecklenburg-Vorpommern DMEK Donor Study). Methods A literature search of PubMed and MEDLINE was conducted to retrieve articles published between September 2013 and May 2021. Seventeen peer-reviewed articles were selected. Design and concept of the prospective COMEDOS are outlined. Results Main interest parameters were the donor diabetes mellitus status, age, and lens status. There is a large heterogeneity regarding the sample size, study design, and investigated parameters. There seems to be a consensus that younger donors are associated with tighter rolls, a more difficult preparation, and unfolding setting. Diabetic donors seem to increase the risk of tissue tearing due to adherences and result more frequently in preparation failure. The COMEDOS aims not only to analyze the diabetes status of the donor, but also to correlate all donor systemic comorbidities and their ophthalmologic history to the DMEK clinical outcome. Furthermore, a correlation of Descemet membrane lamella preparation and surgery outcome is planned. Conclusion Currently, there is a lack of knowledge regarding the effect and impact of donor tissue characteristics on DMEK outcome and complications. An in-depth investigation is planned by the upcoming COMEDOS to close this knowledge gap.![]()
Collapse
|
18
|
Chaussard D, Bloch F, Elnar AA, Zevering Y, Vermion JC, Moskwa R, Perone JM. Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study. PLoS One 2022; 17:e0264401. [PMID: 35202443 PMCID: PMC8870504 DOI: 10.1371/journal.pone.0264401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.
Collapse
Affiliation(s)
- Dimitri Chaussard
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Arpiné Ardzivian Elnar
- Clinical Research Support Unit, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville Regional Hospital Center, Metz, France
| | - Yinka Zevering
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Rémi Moskwa
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
- Institut Jean Lamour, Lorraine University, Nancy, France
- * E-mail:
| |
Collapse
|
19
|
Roy A, Das S. Commentary: Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty. Indian J Ophthalmol 2022; 70:516. [PMID: 35086228 PMCID: PMC9023974 DOI: 10.4103/ijo.ijo_2553_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Aravind Roy
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| |
Collapse
|
20
|
Shah R, Hirwe S, Ashar J, Sengupta S. Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty. Indian J Ophthalmol 2022; 70:511-515. [PMID: 35086227 PMCID: PMC9023935 DOI: 10.4103/ijo.ijo_1329_21] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: To examine the utilization patterns of cornea procured from diseased individuals ≥75 years of age at an eye bank in western India. Methods: In this retrospective study, data from 1,217 eyes of 653 donors with age ≥75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non-clinical purposes (e.g., research, training/discarded), and causes of non-utilization were noted. Results: The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100-cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10–1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52–0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model. Conclusion: More than one-third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization.
Collapse
Affiliation(s)
- Rakesh Shah
- Swaraashi Netralaya, Mumbai, Maharashtra, India
| | | | | | | |
Collapse
|
21
|
Ong HS, Chiam N, Htoon HM, Kumar A, Arundhati A, Mehta JS. The Effects of Donor-Recipient Age and Sex Compatibility in the Outcomes of Deep Anterior Lamellar Keratoplasties. Front Med (Lausanne) 2022; 8:801472. [PMID: 35155480 PMCID: PMC8828935 DOI: 10.3389/fmed.2021.801472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeCorneal transplantations are the commonest allogenic transplant surgeries performed worldwide. Transplantable grade donor cornea is a finite resource. There is thus an impetus for eye banks to optimize the use of each harvested cornea, and clinicians to minimize the risks of graft rejection and failure. With better survival and lower rejection rates, anterior lamellar keratoplasty has gained popularity as an alternative technique to full-thickness penetrating keratoplasty, for the treatment of corneal stromal diseases. This study evaluated the effects of donor-recipient age- and sex-matching on the outcomes of eyes that had undergone deep anterior lamellar keratoplasty (DALK) surgeries.DesignObservational cross-sectional study (national corneal graft registry data).SubjectsAll DALK surgeries performed in a tertiary ophthalmic hospital over an 11-year period.MethodsTo analyse the effects of donor-recipient sex-matching, transplantations were classified as “presumed H-Y incompatible” (male donor to female recipient) or “presumed H-Y compatible” (all other donor-recipient sex combinations). For age-matching, differences in donor and recipient ages were calculated. Cox proportional hazards regressions were used to evaluate the influence of donor-recipient sex-matching and age-matching on graft failure and rejection.Main Outcome MeasuresRates of graft failure and rejection within each group.Results401 eyes were included. 271 (67.6%) transplants were presumed H-Y compatible. 29 (7.2%) grafts failed and 9 (2.2%) grafts rejected. There were trends of lower hazard ratios (HRs) in graft failure and rejection in the presumed H-Y compatible group [HRs: 0.59 (95% CI 0.20–1.77, p = 0.34) and 0.93 (95% CI 0.22–3.89, p = 0.926), respectively]. Median difference in age between recipients and donors was 15.0 years (IQR −2.8–34.3). The HRs of graft failure and rejection were not influenced by donor-recipient age [HRs per 1-year increase in age difference: 0.995 (95% CI 0.98–1.01, p = 0.483) and 1.01 (95% CI 0.99–1.03, p = 0.394), respectively].ConclusionIn eyes that had undergone DALK surgeries, no significant influence of donor-recipient sex- or age-matching on graft rejection and failure was observed. Without strong evidence and the limitations of obtaining sample sizes required for an adequately powered study, the benefits of sex- and age-matching of donors and recipients during graft allocation for DALK surgeries is currently inconclusive.
Collapse
Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Hon Shing Ong
| | - Nathalie Chiam
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
| | - Hla Myint Htoon
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ashish Kumar
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
| | - Anshu Arundhati
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Jodhbir S. Mehta
| |
Collapse
|
22
|
Gómez‐Benlloch A, Montesel A, Pareja‐Aricò L, Mingo‐Botín D, Michael R, Barraquer RI, Alió J. Causes of corneal transplant failure: a multicentric study. Acta Ophthalmol 2021; 99:e922-e928. [PMID: 33421330 DOI: 10.1111/aos.14708] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify the causes of failure of the different surgical corneal graft techniques: penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS This multicentric retrospective study enrolled a consecutive cohort of patients who had undergone any type of keratoplasty between 2001 and 2016. The clinical data were obtained from the patient's medical records, following ethical guidelines, permissions and data protection. The main outcome measured in the study was the cause of graft failure, defined as any irreversible loss of graft transparency capable of compromising vision. The main causes of graft failure were classified as follows: (A) primary graft failure (PGF), (B) immunological rejection, (C) non-rejection (which includes endothelial decompensation without rejection, IOP elevation/glaucoma, diseases of the ocular surface, recurrence of the primary disease, wound dehiscence/hypotonia and trauma, among others) and (D) specific causes of lamellar keratoplasty failure. A descriptive study of the obtained data was carried out. The distribution of the causes of failure was evaluated according to the type of corneal transplant. RESULTS Our research included a cohort of 571 keratoplasty failures, of which 509 met the inclusion criteria. The analysis of the causes of the PK failure showed that immunological allograft rejection represented the main cause, with 28.2% of the failures, followed by surface diseases (17.8%) and endothelial decompensation without rejection (17.3%). For the PK re-grafts group, the main cause of failure was immunological allograft rejection (34.0%), followed by diseases of the ocular surface (18.5%). For the DALK group, the failures mainly occurred due to surface diseases such as limbal stem cell insufficiency, infectious keratitis, keratolysis or persistent epithelial defect (37.8%). However, the main reason for failure in the DSAEK group was endothelial decompensation without rejection (31.9%) while primary graft failure was the main cause of failure in the DMEK group (64.1%). CONCLUSION The main reason for failure in PK was immunological allograft rejection, both in primary and secondary transplants. The leading causes for failure were diseases of the ocular surface in the DALK population, endothelial decompensation without rejection in DSAEK and primary graft failure in DMEK.
Collapse
Affiliation(s)
- Alba Gómez‐Benlloch
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
| | | | - Luis Pareja‐Aricò
- Hospital Clínico Universitario de Valladolid Universidad de Valladolid Valladolid Spain
| | | | - Ralph Michael
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
| | - Rafael I. Barraquer
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
- Universitat Internacional de Catalunya Barcelona Spain
| | - Jorge Alió
- Vissum Miranza Alicante Spain
- Division of Ophthalmology Universidad Miguel Hernández Alicante Spain
| |
Collapse
|
23
|
Romo-Valera C, Pérez-Garrastachu M, Hernáez-Moya R, Rodriguez-Astigarraga M, Romano-Ruiz P, Etxebarria J, Arluzea J, Andollo N. Characterisation of corneas following different time and storage methods for their use as a source of stem-like limbal epithelial cells. Exp Eye Res 2021; 211:108720. [PMID: 34389315 DOI: 10.1016/j.exer.2021.108720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022]
Abstract
The transplantation of expansions of limbal epithelial stem cells (LESC) remains one of the most efficient therapies for the treatment of limbal stem cell deficiency (LSCD) to date. However, the available donor corneas are scarce, and the corneas conserved for long time, under hypothermic conditions (after 7 days) or in culture (more than 28 days), are usually discarded due to poor viability of the endothelial cells. To establish an objective criterion for the utilisation or discarding of corneas as a source of LESC, we characterized, by immunohistochemistry analysis, donor corneas conserved in different conditions and for different periods of time. We also studied the potency of LESCs isolated from these corneas and maintained in culture up to 3 cell passages. We hoped that the study of markers of LESCs present in both the corneoscleral histological sections and the cell cultures would show the adequacy of the methods used for cell isolation and how fit the LESC enrichment of the obtained cell populations to be expanded was. Thus, the expressions of markers of the cells residing in the human limbal and corneal epithelium (cytokeratin CK15 and CK12, vimentin, Collagen VII, p63α, ABCG2, Ki67, Integrin β4, ZO1, and melan A) were analysed in sections of corneoscleral tissues conserved in hypothermic conditions for 2-9 days with post-mortem time (pmt) < 8 h or for 1 day with pmt > 16 h, and in sclerocorneal rims maintained in an organ culture medium for 29 days. Cell populations isolated from donor corneoscleral tissues were also assessed based on these markers to verify the adequacy of isolation methods and the potential of expanding LESCs from these tissues. Positivity for several putative stem cell markers such as CK15 and p63α was detected in all corneoscleral tissues, although a decrease was recorded in the ones conserved for longer times. The barrier function and the ability to adhere to the extracellular matrix were maintained in all the analysed tissues. In limbal epithelial cell cultures, a simultaneous decrease in the melan A melanocyte marker and the putative stem cell markers was detected, suggesting a close relationship between the melanocytes and the limbal stem cells of the niche. Holoclones stained with putative stem cell markers were obtained from long-term, hypothermic, stored sclerocorneal rims. The results showed that the remaining sclerocorneal rims after corneal transplantation, which were conserved under hypothermic conditions for up to 7 days and would have been discarded at a first glance, still maintained their potential as a source of LESC cultures.
Collapse
Affiliation(s)
- Cristina Romo-Valera
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Miguel Pérez-Garrastachu
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Raquel Hernáez-Moya
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Maddalen Rodriguez-Astigarraga
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Paula Romano-Ruiz
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Jaime Etxebarria
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain; Department of Ophthalmology, University Hospital of Cruces, Cruces Plaza S/N, 48903, Barakaldo, Spain; BioCruces Bizkaia Health Research Institute, Begiker, Cruces Plaza S/N, 48903, Barakaldo, Spain
| | - Jon Arluzea
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain
| | - Noelia Andollo
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country, Sarriena, S/N, 48940, Leioa, Spain; BioCruces Bizkaia Health Research Institute, Begiker, Cruces Plaza S/N, 48903, Barakaldo, Spain.
| |
Collapse
|
24
|
Moshirfar M, Odayar VS, McCabe SE, Ronquillo YC. Corneal Donation: Current Guidelines and Future Direction. Clin Ophthalmol 2021; 15:2963-2973. [PMID: 34285462 PMCID: PMC8285277 DOI: 10.2147/opth.s284617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE This review aims to outline current practices and guidelines of corneal donation and eye banking, describes the implications of COVID-19 and emerging diseases on the corneal donor pool, and discusses future trends to improve and increase the efficiency of the processes involved in corneal donation and eye banking. SUMMARY Corneal screening, preservation, corneal storage, and prevention of systemic disease transmission from donor to recipient have been crucial in shaping the policies of the FDA and eye banks across the world. Eye banks globally have developed varying guidelines and criteria for evaluating the viability of donor corneas. Variables such as the age of the donor, medical history, and potential disease transmission are important screening parameters. While known infectious diseases may be transmissible through the cornea, emerging infectious diseases that are not well studied may be more transmissible than other infections. In particular, coronavirus has impacted corneal transplantation as SARS-CoV-2 expression has been detected in corneal tissue and conjunctiva. In recent years, partial-thickness corneal transplantations have been introduced. Lamellar grafts and other corneal layers are now utilized for transplantation of the specific areas that are damaged.
Collapse
Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, 84020, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Utah Lions Eye Bank, Murray, UT, 84107, USA
| | - Varshini S Odayar
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Draper, UT, 84020, USA
- Mission Hills Eye Center, Pleasant Hill, CA, 94523, USA
| | | |
Collapse
|
25
|
Straiko MD, Bauer AJ, Straiko MMW, Potts LB, Chen SY, Tran KD, Terry MA. Donor DMEK Tissue Characteristics: Association With Rebubble Rate and 6-Month Endothelial Cell Loss. Cornea 2021; 39:1267-1273. [PMID: 32558729 DOI: 10.1097/ico.0000000000002398] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether specific donor characteristics influence postoperative rebubble rate and 6-month endothelial cell loss (ECL) in Descemet membrane endothelial keratoplasty (DMEK). METHODS A retrospective analysis of a consecutive series of 857 DMEK surgeries using eye bank-prepared donor tissue was performed between September 2013 and April 2018. DMEK graft characteristics including donor age, preoperative endothelial cell density (ECD), preservation time, death-to-preservation time, and donor diabetes status were analyzed for correlation with rebubble rate and 6-month postoperative ECL. Subgroup analyses of donor age, preoperative ECD, preservation time, death-to-preservation time, preparation-to-surgery time, and diabetes severity were also performed. Statistically significant relationships between donor characteristics and rebubble rate or 6-month postoperative ECL were determined using Pearson correlation, one-way analysis of variance, t test, and χ analysis. RESULTS The overall rate of rebubble after 857 surgeries performed by 7 surgeons during the study period was 12.6%. There was no significant relationship between postoperative rebubble rate and donor age, preoperative ECD, preservation time, death-to-preservation time, preparation-to-surgery time, or donor diabetes status. The subgroup analysis of these characteristics also yielded no significant relationship with rebubble rate. There was also no significant relationship between 6-month postoperative ECL and analyzed donor factors. CONCLUSIONS Donor characteristics such as higher donor age, lower preoperative ECD (<2500), longer preservation time, and donor diabetes did not increase the rebubble rate or the 6-month ECL after DMEK. These results indicate that common surgeon preferences for donor tissues that are younger, fresher, with higher cell count, and without diabetes do not translate into superior postsurgical outcomes.
Collapse
Affiliation(s)
- Michael D Straiko
- Cornea Services, Devers Eye Institute, Portland, OR; and.,Lions VisionGift, Portland, OR
| | | | | | - Luke B Potts
- Cornea Services, Devers Eye Institute, Portland, OR; and
| | - Shin-Yi Chen
- Cornea Services, Devers Eye Institute, Portland, OR; and
| | | | - Mark A Terry
- Cornea Services, Devers Eye Institute, Portland, OR; and.,Lions VisionGift, Portland, OR
| |
Collapse
|
26
|
Kwon HY, Hyon JY, Jeon HS. Effect of Donor Age on Graft Survival in Primary Penetrating Keratoplasty with Imported Donor Corneas. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:35-45. [PMID: 32037748 PMCID: PMC7010478 DOI: 10.3341/kjo.2019.0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/23/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the influence of donor age on corneal graft survival following primary penetrating keratoplasty (PK) with imported donor corneas. Methods The eyes of patients who underwent primary PK with imported donor corneas were classified retrospectively into two groups according to a donor-age cutoff of 65 years. Primary outcome measures were rejection-free graft survival and graft survival. Cox proportional hazard regression analysis was used to assess the factors affecting graft survival. Survival analysis was performed using the Kaplan-Meier method, while differences between groups were examined using a log-rank test. A subgroup analysis of low- and high-risk eyes according to preoperative diagnosis was also performed. Results A total of 140 eyes from 138 patients (age, 58 ± 18 years) were enrolled. Cox regression analysis revealed that the donor age of 65 years or older group presented an increased risk of both graft rejection and failure. Survival analysis revealed that rejection-free graft survival and graft survival rates were higher in eyes in the donor age of less than 65 years group. Finally, in the subgroup analysis, both rejection-free graft survival and graft survival rates were significantly higher in the donor age of less than 65 years group than in the donor age of 65 years or older group, but only in the low-risk subgroup. Conclusions Donor age may correlate with graft survival in primary PK performed with imported donor corneas. Donor age could be a considerable factor in primary PK with imported donor corneas, especially in preoperatively low-risk patients.
Collapse
Affiliation(s)
- Hyeon Yoon Kwon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
27
|
Cassidy D, Beltz J, Jhanji V, Loughnan MS. Recent advances in corneal transplantation for keratoconus. Clin Exp Optom 2021; 96:165-72. [DOI: 10.1111/cxo.12047] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 01/07/2013] [Accepted: 01/18/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dermot Cassidy
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester University, NHS Foundation Trust, Manchester, UK,
- Corneal Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia,
| | - Jacqueline Beltz
- Corneal Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia,
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia,
| | - Vishal Jhanji
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia,
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong,
| | - Michael S Loughnan
- Corneal Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia,
| |
Collapse
|
28
|
Price MO, Mehta JS, Jurkunas UV, Price FW. Corneal endothelial dysfunction: Evolving understanding and treatment options. Prog Retin Eye Res 2020; 82:100904. [PMID: 32977001 DOI: 10.1016/j.preteyeres.2020.100904] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/13/2022]
Abstract
The cornea is exquisitely designed to protect the eye while transmitting and focusing incoming light. Precise control of corneal hydration by the endothelial cell layer that lines the inner surface of the cornea is required for optimal transparency, and endothelial dysfunction or damage can result in corneal edema and visual impairment. Advances in corneal transplantation now allow selective replacement of dysfunctional corneal endothelium, providing rapid visual rehabilitation. A series of technique improvements have minimized complications and various adaptations allow use even in eyes with complicated anatomy. While selective endothelial keratoplasty sets a very high standard for safety and efficacy, a shortage of donor corneas in many parts of the world restricts access, prompting a search for alternatives. Clinical trials are underway to evaluate the potential for self-recovery after removal of dysfunctional central endothelium in patients with healthy peripheral endothelium. Various approaches to using cultured human corneal endothelial cells are also in clinical trials; these aim to multiply cells from a single donor cornea for use in potentially hundreds of patients. Pre-clinical studies are underway with induced pluripotent stem cells, endothelial stem cell regeneration, gene therapy, anti-sense oligonucleotides, and various biologic/pharmacologic approaches designed to treat, prevent, or retard corneal endothelial dysfunction. The availability of more therapeutic options will hopefully expand access around the world while also allowing treatment to be more precisely tailored to each individual patient.
Collapse
Affiliation(s)
- Marianne O Price
- Cornea Research Foundation of America, 9002 N. Meridian St., Suite 212, Indianapolis, IN, USA.
| | - Jodhbir S Mehta
- Singapore National Eye Centre, 11 Third Hospital Ave #08-00, 168751, Singapore
| | - Ula V Jurkunas
- Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA, USA
| | - Francis W Price
- Price Vision Group, 9002 N. Meridian St., Suite 100, Indianapolis, IN, USA
| |
Collapse
|
29
|
Microorganism detection and contamination rate of donor eyes in Japan. Jpn J Ophthalmol 2020; 64:577-584. [PMID: 32924083 DOI: 10.1007/s10384-020-00772-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the microorganism detection and contamination rate of donor eyes. STUDY DESIGN Retrospective study. METHODS In this retrospective study, we reviewed all donor cornea data collected from Kyoto Prefectural University of Medicine (KPUM) Eye Bank, Kyoto, Japan from April 2015 to June 2018, including microbiologic data obtained from conjunctival swabs and preservation medium and findings of postoperative infection from the medical records. RESULTS During the study period, 77 eyes from 44 deceased individuals (mean age at time of death: 75 ± 17.3 years [range, 30-102 years]) were donated to the KPUM Eye Bank after being harvested using standard safety precautions and disinfection procedures. In 49 of the 77 eyes (63.6%), the conjunctival-swab culture revealed microorganisms, with the 3 most commonly detected being methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-sensitive S aureus (MSSA), and methicillin-resistant S aureus (MRSA). The data revealed positive microorganism detection in only 4 (5.2%) of the 77 donor-cornea storage-medium cultures. Positive microorganism detection was found in all the age groups, with no statistical difference between the groups (P > .05). In the eyes enucleated ≥ 2.5 h postmortem, a higher positive microorganism detection occurred (P = .03). During the postoperative follow-up period, there was no record of corneal infection. CONCLUSIONS The preenucleation conjunctival-swab-culture findings revealed that the rate of positive microorganism detection was similar for advanced-age and younger-age donors and that a shorter elapsed time from donor death to postmortem enucleation resulted in less donor-microorganism contamination.
Collapse
|
30
|
Singh RB, Marmalidou A, Amouzegar A, Chen Y, Dana R. Animal models of high-risk corneal transplantation: A comprehensive review. Exp Eye Res 2020; 198:108152. [PMID: 32721424 PMCID: PMC7508940 DOI: 10.1016/j.exer.2020.108152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Over the past century, corneal transplantation has become the most commonly performed allogeneic solid tissue transplantation. Although more than 80% of the corneal transplantations have favorable outcomes, immune-mediated rejection continues to be the major cause of failure in well over 50% of graft recipients that have inflamed and vascularized host beds. Over the past two decades, the progress in our understanding of the immunological pathways that mediate graft rejection has aided in the development of novel therapeutic strategies. In order to successfully test the efficacy of these interventions, it is essential to model the immunological processes occurring as a consequence of corneal transplantation. Herein, we have comprehensively reviewed the established animal models used for replicating the immunopathological processes causing graft rejection in high-risk corneal transplantation settings. We have also discussed the practical and technical differences, as well as biological and immunological variations in different animal models.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anna Marmalidou
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Afsaneh Amouzegar
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yihe Chen
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
31
|
Ong HS, Peh G, Neo DJH, Ang HP, Adnan K, Nyein CL, Morales-Wong F, Bhogal M, Kocaba V, Mehta JS. A Novel Approach of Harvesting Viable Single Cells from Donor Corneal Endothelium for Cell-Injection Therapy. Cells 2020; 9:cells9061428. [PMID: 32526886 PMCID: PMC7349718 DOI: 10.3390/cells9061428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
Donor corneas with low endothelial cell densities (ECD) are deemed unsuitable for corneal endothelial transplantation. This study evaluated a two-step incubation and dissociation harvesting approach to isolate single corneal endothelial cells (CECs) from donor corneas for corneal endothelial cell-injection (CE-CI) therapy. To isolate CECs directly from donor corneas, optimization studies were performed where donor Descemet’s membrane/corneal endothelium (DM/CE) were peeled and incubated in either M4-F99 or M5-Endo media before enzymatic digestion. Morphometric analyses were performed on the isolated single cells. The functional capacities of these cells, isolated using the optimized simple non-cultured endothelial cells (SNEC) harvesting technique, for CE-CI therapy were investigated using a rabbit bullous keratopathy model. The two control groups were the positive controls, where rabbits received cultured CECs, and the negative controls, where rabbits received no CECs. Whilst it took longer for CECs to dislodge as single cells following donor DM/CE incubation in M5-Endo medium, CECs harvested were morphologically more homogenous and smaller compared to CECs obtained from DM/CE incubated in M4-F99 medium (p < 0.05). M5-Endo medium was hence selected as the DM/CE incubation medium prior to enzymatic digestion to harvest CECs for the in vivo cell-injection studies. Following SNEC injection, mean central corneal thickness (CCT) of rabbits increased to 802.9 ± 147.8 μm on day 1, gradually thinned, and remained clear with a CCT of 385.5 ± 38.6 μm at week 3. Recovery of corneas was comparable to rabbits receiving cultured CE-CI (p = 0.40, p = 0.17, and p = 0.08 at weeks 1, 2, and 3, respectively). Corneas that did not receive any cells remained significantly thicker compared to both SNEC injection and cultured CE-CI groups (p < 0.05). This study concluded that direct harvesting of single CECs from donor corneas for SNEC injection allows the utilization of donor corneas unsuitable for conventional endothelial transplantation.
Collapse
Affiliation(s)
- Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
- Eye-Academic Clinical Program (ACP), Duke-National University of Singapore (NUS), Graduate Medical School, Singapore 169857, Singapore
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
- Correspondence: (H.S.O.); (J.S.M.); Tel.: +65-6227-7255 (H.S.O. & J.S.M.); Fax: +65-6227-7290 (H.S.O. & J.S.M.)
| | - Gary Peh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
- Eye-Academic Clinical Program (ACP), Duke-National University of Singapore (NUS), Graduate Medical School, Singapore 169857, Singapore
| | - Dawn Jin Hui Neo
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
| | - Heng-Pei Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
| | - Khadijah Adnan
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
| | - Chan Lwin Nyein
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
| | - Fernando Morales-Wong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
| | - Maninder Bhogal
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
- Cornea Unit, Guy’s & St Thomas’ Hospital, London SE1 7EH, UK
| | - Viridiana Kocaba
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
- Netherlands Institute for Innovative Ocular Surgery, Melles Cornea Clinic, Amnitrans EyeBank Rotterdam, 3071 AA Rotterdam, The Netherlands
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (G.P.); (D.J.H.N.); (H.-P.A.); (K.A.); (C.L.N.); (F.M.-W.); (M.B.); (V.K.)
- Eye-Academic Clinical Program (ACP), Duke-National University of Singapore (NUS), Graduate Medical School, Singapore 169857, Singapore
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore 168751, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
- Correspondence: (H.S.O.); (J.S.M.); Tel.: +65-6227-7255 (H.S.O. & J.S.M.); Fax: +65-6227-7290 (H.S.O. & J.S.M.)
| |
Collapse
|
32
|
Schaub F, Collmer M, Schrittenlocher S, Bachmann BO, Cursiefen C, Hos D. Outcome of Descemet Membrane Endothelial Keratoplasty Using Corneas from Donors ≥80 Years of Age. Am J Ophthalmol 2020; 211:200-206. [PMID: 31837315 DOI: 10.1016/j.ajo.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/20/2019] [Accepted: 12/01/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether corneas from donors ≥80 years old are suitable for Descemet membrane endothelial keratoplasty (DMEK). DESIGN Retrospective, comparative, interventional case series. METHODS Records of 1,765 consecutive DMEKs were reviewed and matched with corresponding donor tissue data. Older donors (≥80 years of age) were compared to younger donors (<80 years). Outcome measurements in DMEK recipients included best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), central corneal thickness (CCT) at 3 and 6 months and at 1, 2, and 3 years' follow-up and re-bubbling rates. RESULTS Of 1,748 DMEKs, 284 (16.2%) were performed with older donor lamellae (mean donor age, 83.96 ± 3.19 years; range, 80-94 years) and 1,464 (83.7%) with younger donor tissue (mean donor age, 65.27 ± 9.57 years; range, 17-79). BSCVA results were comparable for all postoperative time points. CCT results for younger donors were more favorable in the early postoperative course (P < 0.001 at 6 months; and P < 0.001 at 1 year), whereas mid-term results were comparable in both groups. ECD values were significantly higher in donors <80 years of age preoperatively and during the first 2 postoperative years (P ≤ 0.024). Overall re-bubbling rates were comparable in both groups. CONCLUSIONS Older donors, ≥80 to 94 years of age, seem to produce comparable mid-term functional results following DMEK surgery compared to younger donors. The use of corneas from donors aged ≥80 for DMEK surgery may therefore be a promising approach to counteract global donor shortage.
Collapse
Affiliation(s)
- Friederike Schaub
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Maurice Collmer
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Silvia Schrittenlocher
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn O Bachmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Germany
| |
Collapse
|
33
|
Pessoa JLE, Schirmer J, Freitas DD, Knihs NDS, Roza BDA. Ocular tissue distribution in the State of São Paulo: analysis on corneal discarding reasons. Rev Lat Am Enfermagem 2019; 27:e3196. [PMID: 31618389 PMCID: PMC6792342 DOI: 10.1590/1518-8345.3041.3196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/18/2019] [Indexed: 11/22/2022] Open
Abstract
Objective to identify the reasons for refusal of corneas. Method this was a cross-sectional, retrospective, descriptive and correlational
study composed of 5,560 optical corneas. The information was taken from the
notification, organ procurement and distribution centers database as well as
donor records. Descriptive statistics were used for the analysis of
categorical variables and specific tests with a significance level of 5% for
assessing the associations between variables. This study met the ethical
aspects of scientific research. Results 60% of the donors were male and 40% died by circulatory problems. The main
reason for refusal as informed by transplant teams is the donor’s age and
the endothelial cell count. For each year added to the donor’s age, there is
a 1% decrease in the chance that this cornea will be used for
transplantation, and the increase of 100 cells per mm2 increases the chances
that this cornea will be used by 9%. Conclusion the main cause of refusal in the acceptance of corneal tissue is related to
the age and the endothelial cell count.
Collapse
Affiliation(s)
- João Luis Erbs Pessoa
- Secretaria de Saúde do Estado de São Paulo, Central de Transplantes, São Paulo, SP, Brasil
| | - Janine Schirmer
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brasil
| | - Denise de Freitas
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil
| | | | | |
Collapse
|
34
|
Patel SV. Towards Clinical Trials in Fuchs Endothelial Corneal Dystrophy: Classification and Outcome Measures-The Bowman Club Lecture 2019. BMJ Open Ophthalmol 2019; 4:e000321. [PMID: 31414054 PMCID: PMC6668606 DOI: 10.1136/bmjophth-2019-000321] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/12/2019] [Indexed: 12/13/2022] Open
Abstract
The surgical treatment of Fuchs endothelial corneal dystrophy (FECD) has advanced dramatically over the last two decades. Penetrating keratoplasty has been superseded by various iterations of endothelial keratoplasty, and currently, surgical removal of host Descemet membrane without keratoplasty is being investigated. These surgical advances have been accompanied by significant improvement of our understanding of the underlying disease mechanisms, not least the discovery that FECD in western populations is predominantly an intronic trinucleotide repeat expansion disorder in the transcription factor 4 gene that results in RNA toxicity and mis-splicing. Understanding the disease mechanisms augurs well for developing targeted molecular medical therapies, which will require careful clinical investigation through trials to prove their efficacy and safety. As the field advances towards clinical trials, investigators should carefully define the disease state being treated and consider the options for outcome measures relevant to the type of intervention. FECD, and the outcomes of interventions to treat the disease, can be measured in terms of corneal morphology, corneal function and clinical impact. Standardising the approach for defining FECD and careful thought about the outcomes of intervention that are reported will help make the results of future trials for FECD applicable in clinical practice.
Collapse
|
35
|
Lass J, Benetz BA, Verdier DD, Szczotka-Flynn LB, Ayala AR, Liang W, Aldave AJ, Dunn SP, McCall T, Mian SI, Navarro LC, Patel SV, Pramanik S, Rosenwasser GO, Ross KW, Terry MA, Kollman C, Gal RL, Beck RW. Corneal Endothelial Cell Loss 3 Years After Successful Descemet Stripping Automated Endothelial Keratoplasty in the Cornea Preservation Time Study: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 135:1394-1400. [PMID: 29127432 DOI: 10.1001/jamaophthalmol.2017.4970] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Demonstrating that endothelial cell loss following Descemet stripping automated endothelial keratoplasty (DSAEK) is independent of donor cornea preservation time (PT) could increase the pool of corneal tissue available for keratoplasty. Objective To determine whether endothelial cell loss 3 years after successful DSAEK is related to PT. Design, Setting, and Participants A multicenter, double-masked, randomized clinical trial included 40 clinical sites (70 surgeons) in the United States, with donor corneas provided by 23 US eye banks. A total of 945 eyes of 769 participants were included in the Cornea Preservation Time Study that had not experienced graft failure 3 years after DSAEK, performed primarily for Fuchs endothelial corneal dystrophy (96% of the cohort). The study was conducted from April 16, 2012, to June 5, 2017. Interventions DSAEK with random assignment of a donor cornea with PT of 0 to 7 days (0-7d PT) or 8 to 14 days (8-14d PT). Main Outcomes and Measures Endothelial cell density (ECD) at 3 years determined by a central image analysis reading center from clinical specular or confocal central endothelial images. Results Nine hundred forty-five eyes of 769 participants (median age, 70 years [range, 42-90 years], 60.8% women, 93.0% white) in the Cornea Preservation Time Study that had not experienced graft failure 3 years after DSAEK were included. At the initial eye bank tissue screening, mean (SD) central ECD was 2746 (297) cells/mm2 in the 0-7d PT group (n = 485) and 2723 (284) cells/mm2 in the 8-14d PT group (n = 460). At 3 years, the mean (SD) ECD decreased from baseline by 37% (21%) in the 0-7d PT group and 40% (22%) in the 8-14d PT group to 1722 (626) cells/mm2 and 1642 (631) cells/mm2, respectively (mean difference, 73 cells/mm2; 95% CI, 8-138 cells/mm2; P = .03). When analyzed as a continuous variable (days), longer PT was associated with lower ECD (mean difference by days, 15 cells/mm2; 95% CI, 4-26 cells/mm2; P = .006). Endothelial cell loss (ECL) was comparable from 4 to 13 days’ PT (n = 878; 36%-43% when tabulated by day). Available extension study ECD results at 4 years mirrored those at 3 years in the 203 eyes in the 0-7d PT group (mean [SD] ECD, 1620 [673] cells/mm2 and mean [SD] ECL, 41% [23%]) and 209 eyes in the 8-14d PT group (mean [SD] ECD, 1537 [683] cells/mm2 and mean [SD] ECL, 44% [23%]) (mean difference, 112 cells/mm2; 95% CI, 5-219 cells/mm2; P = .04). Conclusions and Relevance Although ECL 3 years after Descemet stripping automated endothelial keratoplasty is greater with longer PT, the effect of PT on ECL is comparable from 4 to 13 days’ PT.
Collapse
Affiliation(s)
- Jonathan Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | - Beth Ann Benetz
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | | | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | | | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | - Anthony J Aldave
- Stein Eye Institute, UCLA (University of California, Los Angeles)
| | | | | | | | | | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | | |
Collapse
|
36
|
Patel SV, Lass JH, Benetz BA, Szczotka-Flynn LB, Cohen NJ, Ayala AR, Maguire MG, Drury DC, Dunn SP, Jeng BH, Jones MF, Menegay HJ, Oliva MS, Rosenwasser GOD, Seedor JA, Terry MA, Verdier DD. Postoperative Endothelial Cell Density Is Associated with Late Endothelial Graft Failure after Descemet Stripping Automated Endothelial Keratoplasty. Ophthalmology 2019; 126:1076-1083. [PMID: 30790587 DOI: 10.1016/j.ophtha.2019.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/17/2019] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To determine whether preoperative endothelial cell density (ECD) and postoperative ECD after Descemet stripping automated endothelial keratoplasty (DSAEK) are associated with late endothelial graft failure (LEGF) in the Cornea Preservation Time Study (CPTS). DESIGN Cohort study within a multicenter, randomized clinical trial. PARTICIPANTS A total of 1007 individuals (1223 study eyes), mean age 70 years, undergoing DSAEK for Fuchs' dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE) (6% of eyes) and followed for up to 5 years. METHODS Central ECD was determined by a central image analysis reading center. Preoperative ECD was determined for 1209 eyes that did not fail and 14 eyes that experienced LEGF. The ECD at 6 and 12 months after DSAEK, the change in ECD from preoperative to 6 and 12 months, surgeon-reported operative complications, and postoperative graft dislocation were investigated for an association with LEGFs unrelated to other postoperative events. Univariable and multivariable Cox proportional hazards regression models were used to assess associations. MAIN OUTCOME MEASURES Late endothelial graft failure and its associations with pre- and postoperative ECD and operative complications. RESULTS The cumulative probability of LEGF was 1.3% (95% confidence interval [CI], 0.8%-2.4%). Median (interquartile range [IQR]) preoperative ECDs were similar for eyes with LEGF (2523; 2367-3161) cells/mm2) and eyes without failure (2727; 2508-2973) cells/mm2) (P = 0.34). The ECD at 6 months was associated with LEGF (P < 0.001) in time-to-event analyses, whereas preoperative ECD was not (P = 0.55). The cumulative incidence (95% CI) of LEGF was 6.5% (3.0%, 14.0%) for 97 grafts with a 6-month ECD less than 1200 cells/mm2, 0.3% (0.0%, 2.4%) for 310 grafts with a 6-month ECD between 1200 and 2000 cells/mm2, and 0.6% (0.1%, 2.7%) for 589 grafts with a 6-month ECD greater than 2000 cells/mm2. In multivariable analyses, ECD at 6 months and operative complications were both associated with LEGF (P = 0.002 and P = 0.01, respectively), whereas graft dislocation was not (P = 0.61). CONCLUSIONS In eyes undergoing DSAEK, preoperative ECD is unrelated to LEGF, whereas lower ECD at 6 months is associated with LEGF. Early endothelial cell loss after DSAEK and intraoperative complications should be minimized to improve graft survival.
Collapse
Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jonathan H Lass
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio.
| | - Beth Ann Benetz
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
| | - Loretta B Szczotka-Flynn
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
| | | | | | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Steven P Dunn
- Michigan Cornea Consultants, P.C., Southfield, Michigan
| | - Bennie H Jeng
- University of California-San Francisco, San Francisco, California (now the University of Maryland, Baltimore, Maryland)
| | | | - Harry J Menegay
- Case Western Reserve University Department of Ophthalmology and Visual Sciences and University Hospitals Eye Institute, Cleveland, Ohio
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE To analyze the number of discarded donated corneas and the causes associated with discard in southern Brazil. METHODS This retrospective, cross-sectional, and analytic study of donor corneal discards and their associated factors and geospatial distribution was based on a macroregional strategy conducted from 2011 to 2015 in Paraná, southern Brazil. The dataset included all cornea donations from patients who died of cardiac arrest at ages between 3 and 70 years. RESULTS A total of 9290 donor corneas were identified from 4645 donor patients; of these corneas, 4235 (45.6%) were discarded and 5055 (54.4%) transplanted. Mean age of the donors was 51.13 ± 14.30 years. The main causes of discard were positive serology (49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and others (16.0%). The discard rate was higher in the 50 to 64 year age group. CONCLUSIONS The corneal discard rate was high in all macroregions studied, with positive serology, viability, and quality of the donated corneas being the main causes of discard. Discards were more prevalent in older age groups (50-64 years and 65 or above age groups). Considering the presented results, the assessment process of potential cornea donors should be changed to reduce losses and costs.
Collapse
|
38
|
Feizi S. Corneal endothelial cell dysfunction: etiologies and management. Ther Adv Ophthalmol 2018; 10:2515841418815802. [PMID: 30560230 PMCID: PMC6293368 DOI: 10.1177/2515841418815802] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
A transparent cornea is essential for the formation of a clear image on the
retina. The human cornea is arranged into well-organized layers, and each layer
plays a significant role in maintaining the transparency and viability of the
tissue. The endothelium has both barrier and pump functions, which are important
for the maintenance of corneal clarity. Many etiologies, including Fuchs’
endothelial corneal dystrophy, surgical trauma, and congenital hereditary
endothelial dystrophy, lead to endothelial cell dysfunction. The main treatment
for corneal decompensation is replacement of the abnormal corneal layers with
normal donor tissue. Nowadays, the trend is to perform selective endothelial
keratoplasty, including Descemet stripping automated endothelial keratoplasty
and Descemet’s membrane endothelial keratoplasty, to manage corneal endothelial
dysfunction. This selective approach has several advantages over penetrating
keratoplasty, including rapid recovery of visual acuity, less likelihood of
graft rejection, and better patient satisfaction. However, the global limitation
in the supply of donor corneas is becoming an increasing challenge,
necessitating alternatives to reduce this demand. Consequently, in
vitro expansion of human corneal endothelial cells is evolving as a
sustainable choice. This method is intended to prepare corneal endothelial cells
in vitro that can be transferred to the eye. Herein, we
describe the etiologies and manifestations of human corneal endothelial cell
dysfunction. We also summarize the available options for as well as recent
developments in the management of corneal endothelial dysfunction.
Collapse
Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
| |
Collapse
|
39
|
Risk Factors for Endothelial Decompensation after Penetrating Keratoplasty and Its Novel Therapeutic Strategies. J Ophthalmol 2018; 2018:1389486. [PMID: 30581601 PMCID: PMC6276470 DOI: 10.1155/2018/1389486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose To review the risk factors and pathogenesis of endothelial decompensation after penetrating keratoplasty (PKP) and its novel therapeutic strategies. Methods Literature review. Results As the major cause of graft failure in PKP, endothelial decompensation of corneal allograft is considered an irreversible decrease in endothelial cell density and endothelial dysfunction. Various risk factors, including donor status and operative and recipient factors, have been found to be associated with this pathological process. Operative factors like graft size and recipient factors such as indications, glaucoma, or glaucoma surgery history are highly associated with the occurrence of endothelial decompensation, while others are still under investigation. Although the mechanism of these risk factors remains unclear, pathogenesis can be summarized as an acute and chronic loss of endothelium, and cell exchange between donor and recipient is at the core of chronic cell loss. Endothelial keratoplasty has been a useful alternative to repeat standard PKP in eyes with failed grafts. Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) following failed PKP provide more rapid visual recovery and achieve better rates of graft survival than those of a second PKP. Conclusions Any direct or indirect damage to the endothelium could cause the loss, morphological changes, and dysfunction of endothelial cells. Graft size, indications, and recipient glaucoma or glaucoma surgery history are risk factors for endothelial decompensation. DSAEK and DMEK are novel therapeutic strategies for failed PKP grafts and have potential superiorities compared with repeat PKP.
Collapse
|
40
|
Terry MA, Aldave AJ, Szczotka-Flynn LB, Liang W, Ayala AR, Maguire MG, Croasdale C, Daoud YJ, Dunn SP, Hoover CK, Macsai MS, Mauger TF, Pramanik S, Rosenwasser GOD, Rose-Nussbaumer J, Stulting RD, Sugar A, Tu EY, Verdier DD, Yoo SH, Lass JH. Donor, Recipient, and Operative Factors Associated with Graft Success in the Cornea Preservation Time Study. Ophthalmology 2018; 125:1700-1709. [PMID: 30098353 PMCID: PMC6196643 DOI: 10.1016/j.ophtha.2018.08.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To associate donor, recipient, and operative factors with graft success 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). DESIGN Cohort study within a multicenter, double-masked, randomized clinical trial. PARTICIPANTS One thousand ninety individuals (1330 study eyes) with a median age of 70 years undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE; 6% of eyes). METHODS Eyes undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (n = 675) or 8 to 14 days (n = 655). Donor, recipient, and operative parameters were recorded prospectively. Graft failure was defined as regraft for any reason, a graft that failed to clear by 8 weeks after surgery, or an initially clear graft that became and remained cloudy for 90 days. Failure in the first 8 weeks was classified further as primary donor failure or early failure, in the absence or presence of operative complications, respectively. Proportional hazards and logistic regression models were used to estimate risk ratios (RR) and 99% confidence intervals (CIs) for graft failure. MAIN OUTCOME MEASURES Graft success at 3 years. RESULTS One thousand two hundred fifty-one of 1330 grafts (94%) remained clear at 3 years and were considered successful. After adjusting for PT, tissue from donors with diabetes (RR, 2.35; 99% CI, 1.03-5.33) and operative complications (RR, 4.21; 99% CI, 1.42-12.47) were associated with increased risk for primary or early failure. Preoperative diagnosis of PACE (RR, 3.59; 99% CI, 1.05-12.24) was associated with increased risk for late failure by 3 years after surgery compared with Fuchs dystrophy. Graft success showed little variation among other factors evaluated, including donor age (RR, 1.19 per decade; 99% CI, 0.91-1.56 per decade), preoperative donor endothelial cell density (RR, 1.10 per 500 cells; 99% CI, 0.74-1.63 per 500 cells), graft diameter (RR, 1.22 per 1 mm; 99% CI, 0.39-3.76 per 1 mm), and injector use for graft insertion (RR, 0.92; 99% CI, 0.40-2.10). CONCLUSIONS Descemet stripping automated endothelial keratoplasty success in the early and entire postoperative period is more likely when the donor did not have diabetes and was without operative complications and in the long-term postoperative period in recipients with Fuchs dystrophy compared with those with PACE. Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study.
Collapse
Affiliation(s)
| | - Anthony J Aldave
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio
| | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Yassine J Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Steven P Dunn
- Michigan Cornea Consultants, PC, Southfield, Michigan
| | | | | | - Thomas F Mauger
- The Ohio State University Wexner Medical Center, Havener Eye Institute, Columbus, Ohio
| | | | | | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | | | - Alan Sugar
- University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan
| | - Elmer Y Tu
- University of Illinois Chicago Eye and Ear Infirmary, Chicago, Illinois
| | | | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
| |
Collapse
|
41
|
Cruz GKP, Ferreira Júnior MA, Balbino da Silva S, de Azevedo IC, Santos VEP, Ivo ML. Chronological Factors of the Process of Donation and Classification of Corneal Tissue. Transplant Proc 2018; 50:827-830. [PMID: 29661447 DOI: 10.1016/j.transproceed.2018.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The quality of corneal tissue is influenced by several factors inherent to the recipient, donor, donation process, and transplantation that may primarily or secondarily interfere in the survival of a corneal graft. OBJECTIVE The objective of this study was to identify the factors inherent to the donation process, specifically related to the harvesting and processing of tissue and to the donor, that may interfere with the quality of corneal tissue. MATERIALS AND METHODS This was a cross-sectional, descriptive, and analytical study carried out from January to April 2015 at the Onofre Lopes University Hospital, Natal/RN, Brazil. A survey of the keratoplasties performed between the years 2010 and 2014 was carried out, totaling 258 donated corneas. RESULTS The mean age of donors was 42.08 years, ranging from 2-80 years. As for quality, 64.45% of the corneas were classified as good, 23.05% as regular, 11.33% as poor, and 1.17% as excellent. The mean time between death and preservation was approximately 7 hours and 15 minutes, and the mean time elapsed until use was 10 days after immersion in preservation medium. DISCUSSION AND CONCLUSIONS Factors inherent in the donation process that may interfere with the quality of the corneal graft correspond to factors of a chronological nature: donor age and time elapsed between death and preservation of the graft.
Collapse
Affiliation(s)
- G K P Cruz
- Department of Nursing, Federal University of Rio Grande do Norte, Natal-RN, Brazil.
| | - M A Ferreira Júnior
- Department of Nursing, Federal University of Mato Grosso do Sul, Campo Grande-MS, Brazil
| | - S Balbino da Silva
- Residency in Nursing in Infectious Diseases, University Hospital Oswaldo Cruz, Recife-PE, Brazil
| | - I C de Azevedo
- Department of Nursing, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - V E P Santos
- Department of Nursing, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - M L Ivo
- Department of Nursing, Federal University of Mato Grosso do Sul, Campo Grande-MS, Brazil
| |
Collapse
|
42
|
Freitas LSM, Rocon PC, de Almeida AV, Erlacher RGN, Paro FM. Corneal Donor Profile and Evolution of Corneal Donation in a Brazilian State Where the Number of Individuals on the Waiting List Reached Zero But Increased Again. Transplant Proc 2018; 50:509-512. [PMID: 29579837 DOI: 10.1016/j.transproceed.2017.12.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND In most countries, the amount of corneal graft tissue available for transplantation is insufficient to meet demand. In 2010, there were 459 patients on the waiting list for corneal transplantation (WLCT) in Espirito Santo (ES), a Brazilian state with 3,885,000 inhabitants. Several strategies were implemented to reduce the number of individuals on the WLCT, which reached zero in 2011. Studies on the evolution of corneal donation contribute to reducing the WLCT worldwide. The aim of this study was to describe the evolution of corneal donation in ES and the profile of corneal donors from 2010 to 2013. METHODS This was a retrospective study. The data were collected from records referring to donations of corneas and from the archives of the Center for Organ Procurement and Distribution of ES. Statistical software was used to perform descriptive analysis of the data. RESULTS The sample consisted of 1359 donors, aged 46.82 ± 17.32 (mean ± standard deviation), 70.1% of whom were male. Most of the consent forms for donation were signed by the sons of the donors. In 2011, there was a major increase (105%) in the number of corneal transplants compared with 2010; consequently, the number of patients on the WLCT reached zero, but increased again, reaching 139 patients in 2013. CONCLUSION This study shows that strategies to increase corneal donations should be continued even after reduction or elimination waiting time on the WLCT.
Collapse
Affiliation(s)
- L S M Freitas
- Departamento de Educação Integrada em Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - P C Rocon
- Departamento de Educação Integrada em Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - A V de Almeida
- Associação Pró-Vidas Transplantes, Vitória, Espírito Santo, Brazil
| | - R G N Erlacher
- Secretaria Estadual de Saúde, Vitória, Espírito Santo, Brazil
| | - F M Paro
- Departamento de Educação Integrada em Saúde, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
| |
Collapse
|
43
|
Dayoub JC, Cortese F, Anžič A, Grum T, de Magalhães JP. The effects of donor age on organ transplants: A review and implications for aging research. Exp Gerontol 2018; 110:230-240. [PMID: 29935294 PMCID: PMC6123500 DOI: 10.1016/j.exger.2018.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/21/2022]
Abstract
Despite the considerable amount of data available on the effect of donor age upon the outcomes of organ transplantation, these still represent an underutilized resource in aging research. In this review, we have compiled relevant studies that analyze the effect of donor age in graft and patient survival following liver, kidney, pancreas, heart, lung and cornea transplantation, with the aim of deriving insights into possible differential aging rates between the different organs. Overall, older donor age is associated with worse outcomes for all the organs studied. Nonetheless, the donor age from which the negative effects upon graft or patient survival starts to be significant varies between organs. In kidney transplantation, this age is within the third decade of life while the data for heart transplantation suggest a significant effect starting from donors over age 40. This threshold was less defined in liver transplantation where it ranges between 30 and 50 years. The results for the pancreas are also suggestive of a detrimental effect starting at a donor age of around 40, although these are mainly derived from simultaneous pancreas-kidney transplantation data. In lung transplantation, a clear effect was only seen for donors over 65, with negative effects of donor age upon transplantation outcomes likely beginning after age 50. Corneal transplants appear to be less affected by donor age as the majority of studies were unable to find any effect of donor age during the first few years posttransplantation. Overall, patterns of the effect of donor age in patient and graft survival were observed for several organ types and placed in the context of knowledge on aging. Data on the effects of donor age upon the outcomes of organ transplantation are an underutilized resource in biogerontology We compiled data on the effect of donor age following liver, kidney, pancreas, heart, lung and cornea transplantation Older donor age is associated with worse outcomes for all the organs studied The donor age from which the negative effects upon survival starts to be significant varies between organs
Collapse
Affiliation(s)
- Jose Carlos Dayoub
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - Franco Cortese
- Biogerontology Research Foundation, Research Department, Oxford, United Kingdom
| | - Andreja Anžič
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - Tjaša Grum
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - João Pedro de Magalhães
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom; Biogerontology Research Foundation, Research Department, Oxford, United Kingdom.
| |
Collapse
|
44
|
|
45
|
Vicente A, Byström B, Lindström M, Stenevi U, Pedrosa Domellöf F. Aniridia-related keratopathy: Structural changes in naïve and transplanted corneal buttons. PLoS One 2018; 13:e0198822. [PMID: 29889891 PMCID: PMC5995400 DOI: 10.1371/journal.pone.0198822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/26/2018] [Indexed: 01/27/2023] Open
Abstract
Background To study structural changes in naïve and surgically treated corneas of aniridia patients with advanced aniridia-related keratopathy (ARK). Methods and findings Two naïve corneal buttons from patients with advanced ARK submitted to penetrating keratoplasty for the first time, one corneal button from an ARK patient that had undergone a keratolimbal allograft (KLAL), two corneal buttons from ARK patients who had previously undergone centered or decentered transplantation and were now retransplanted and two adult healthy donor control corneas were processed for immunohistochemistry. Antibodies against extracellular matrix components in the stroma and in the epithelial basement membrane (collagen I and IV, collagen receptor α11 integrin and laminin α3 chain), markers of fibrosis, wound healing and vascularization (fibronectin, tenascin-C, vimentin, α-SMA and caveolin-1), cell division (Ki-67) and macrophages (CD68) were used. Naïve ARK, KLAL ARK corneas and transplanted corneal buttons presented similar histopathological changes with irregular epithelium and disruption or absence of epithelial basal membrane. There was a loss of the orderly pattern of collagen lamellae and absence of collagen I in all ARK corneas. Vascularization was revealed by the presence of caveolin-1 and collagen IV in the pannus of all ARK aniridia corneas. The changes observed in decentered and centered transplants were analogous. Conclusions Given the similar pathological features of all cases, conditions inherent to the host seem to play an important role on the pathophysiology of the ARK in the long run.
Collapse
Affiliation(s)
- André Vicente
- Department of Clinical Science, Ophthalmology, Umeå University, Umeå, Sweden
| | - Berit Byström
- Department of Clinical Science, Ophthalmology, Umeå University, Umeå, Sweden
| | - Mona Lindström
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden
| | - Ulf Stenevi
- Department of Ophthalmology, University of Gothenburg, Gothenburg, Sweden
| | - Fátima Pedrosa Domellöf
- Department of Clinical Science, Ophthalmology, Umeå University, Umeå, Sweden
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden
- * E-mail:
| |
Collapse
|
46
|
Singar-Ozdemir E, Burcu A, Oral B, Yalniz-Akkaya Z, Uzman S, Tamer Kaderli S, Ornek F. Effect of Donor Cornea on the Surgical Outcomes of Penetrating Keratoplasty: Imported Cornea Versus Domestic Cornea. EXP CLIN TRANSPLANT 2018. [PMID: 29607781 DOI: 10.6002/ect.2018.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In this study, we compared the surgical outcomes of penetrating keratoplasty using domestic and imported donor corneas. MATERIALS AND METHODS We retrospectively evaluated 200 eyes and 200 consecutive patients who underwent penetrating keratoplasty by using domestic and imported donor corneas between January 2013 and December 2013. The donor characteristics, preoperative clinical features, and clinical outcomes at 6, 12, 24, and 36 months were assessed. RESULTS No significant differences existed between the 2 groups with respect to age, sex, lateralization, and penetrating keratoplasty indication (P > .05). Donor age was lower (P = .012), the death-to-preservation time and the preservation-to-surgery time were shorter, the rate of epithelial defect was lower, and the endothelial cell count was higher in the domestic group (P < .001). The 2 groups were also similar in terms of developing persistent epithelial defect, glaucoma, keratitis, and graft survival (P > .05). CONCLUSIONS We observed no significant differences in clinical outcomes during and after penetrating keratoplasty surgery between imported and domestic donor corneas.
Collapse
Affiliation(s)
- Evin Singar-Ozdemir
- From the Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
47
|
[Influence of the donor age on graft survival : Is the demographic change also important for corneal tissue donation?]. Ophthalmologe 2018; 114:440-444. [PMID: 27785556 DOI: 10.1007/s00347-016-0381-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The success of corneal transplantation highly depends on the quality of the used graft. Various factors play a crucial role such as a perfect stroma without optically relevant, centrally located cloudiness or changes (e. g. scars) or an adherent Descemet membrane. One of the most important parameters is the quality of the endothelial cell layer with a sufficiently large endothelial cell count. An open question is so far whether the donor age affects corneal quality and therefore has an impact on the success of transplantation. A comprehensive review of the available literature revealed that a large amount of scientific data on the influence of donor age exist to answer this question. In a variety of studies, no significant dependence of graft quality of donor age could be detected. Rather the studies prove that graft survival depends primarily on the state of the endothelial cell layer, and postoperative endothelial cell loss must be considered as a major cause of graft failure. Extensive quality assurance procedures in tissue preparation and cornea processing in the eye banks in Germany (Europe) ensures that only corneas with tested high quality are allocated for transplantation regardless of the donor age. Against the background of an aging population, the use of grafts from older donors should not be waived.
Collapse
|
48
|
Kapur N, Gunda S, Dixit S, Chauhan L, Acharya M, Mathur U. Effect of transfer of donor corneal tissue from McCarey-Kaufmann medium to Optisol-GS on corneal endothelium. Indian J Ophthalmol 2018; 66:219-222. [PMID: 29380761 PMCID: PMC5819098 DOI: 10.4103/ijo.ijo_677_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the effect of transfer of donor corneal tissue from McCarey–Kaufmann (MK) medium to Optisol-GS on corneal endothelium. Methods: This was a prospective, randomized comparative study. Twenty paired human donor corneal tissues of optical quality were retrieved. One tissue of the pair was preserved in Optisol-GS preservative medium (Group A) and other tissue of the pair in MK medium (Group B) at the time of corneoscleral disc excision. Within 12 h of retrieval, each cornea was evaluated using slit-lamp biomicroscopic examination and specular microscopic analysis. Group B corneas were transferred to Optisol-GS medium within 48–53 h of retrieval. Specular analysis of the paired corneas was repeated 3 h after transferring to Optisol-GS. On day 7 of storage, specular analysis of both the tissues was repeated. Results: The average age of the donor at the time of death was 29 years (16–68 years). The reduction in endothelial cell count, from baseline, in Groups A and B was 5.5% and 5.8% (P = 0.938) on the 3rd day and 8.2% and 12.6% (P = 0.025) on the 7th day, respectively, postretrieval. The coefficient of variation (CV) increased by 36% (P = 0.021) and hexagonality reduced by 19% (P = 0.007) on day 7. All tissues retained an endothelial cell density higher than the accepted critical level for penetrating keratoplasty. Conclusion: Significant endothelial cell loss was noted while transferring tissues from one medium to another, necessitating the need for reevaluation of transferred tissues before utilization.
Collapse
Affiliation(s)
- Neha Kapur
- Dr. Shroff 's Charity Eye Hospital, New Delhi, India
| | - Sridevi Gunda
- Dr. Shroff 's Charity Eye Hospital, New Delhi, India
| | | | | | | | - Umang Mathur
- Dr. Shroff 's Charity Eye Hospital, New Delhi, India
| |
Collapse
|
49
|
Affiliation(s)
| | - Pankaj Gupta
- University Hospitals Eye Institute and Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio 44106;,
| | - Jonathan Lass
- University Hospitals Eye Institute and Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio 44106;,
| | | |
Collapse
|
50
|
Patel D, Tandon R, Ganger A, Vij A, Lalwani S, Kumar A. Study of death to preservation time and its impact on utilisation of donor corneas. Trop Doct 2017; 47:365-370. [PMID: 28610538 DOI: 10.1177/0049475517713406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To evaluate the impact of death-to-preservation time (DPT) on effective utilisation of donor corneas. In a prospective observational study conducted at our tertiary eye centre, donated corneas received over a 15-month period from November 2011 to January 2013 were evaluated. Donor age, donor refrigeration (done or not), DPT, endothelial cell density (ECD), corneal grading, clinical utilisation and surgical outcome after graft transplantation were noted. To analyse the impact of different DPT on donor cornea transplantation, primary outcome measures (corneal grading and endothelial cell density) and secondary outcome measures (primary graft failure and graft infection) were analysed. A total of 990 corneas were assessed. Primary outcomes showed no significant difference for higher DPT ( P > 0.01). ECD, where DPT was >12 h, was better for refrigerated corneas ( P < 0.001). Prolonged DPT had no significant effect on primary graft failure ( P = 0.131) and graft infection ( P = 0.137) in the first month after transplantation. We find that DPT should not be the only criteria to assess the cornea quality; other donor characteristics should be considered equally important. Donor refrigeration should be encouraged in cases where early retrieval is not possible.
Collapse
Affiliation(s)
- Dhaval Patel
- 1 Cornea & Refractive Surgery Unit, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- 1 Cornea & Refractive Surgery Unit, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Ganger
- 1 Cornea & Refractive Surgery Unit, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aarti Vij
- 2 Organ Retrieval & Banking Organisation, Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- 3 Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Kumar
- 3 Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|