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Romano D, Aiello F, Parekh M, Levis HJ, Gadhvi KA, Moramarco A, Viola P, Fontana L, Semeraro F, Romano V. Incidence and management of early postoperative complications in lamellar corneal transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:3097-3111. [PMID: 37103622 PMCID: PMC10134734 DOI: 10.1007/s00417-023-06073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.
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Affiliation(s)
- Davide Romano
- Ophthalmology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kunal A Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Viola
- Department of Ophthalmology, San Bartolo Hospital, Vicenza, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Semeraro
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Vito Romano
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy.
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Fate of endothelial cells after intrastromal implantation of Descemet's membrane-endothelial cell tissue. Cell Tissue Bank 2020; 21:535-545. [PMID: 32488653 DOI: 10.1007/s10561-020-09840-5] [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: 03/19/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
In non-Descemet Stripping Automated Endothelial Keratoplasty (nDSAEK), the host DM and endothelium are not removed surgically before the introduction of the posterior lamellar graft; the result is that the patient has both the healthy donor endothelium and the diseased or residual host endothelium. Conversely, DSAEK tissues, that are inserted with inverted polarity (upside down), do not survive and the graft fails. While the mechanism of endothelial cell transplantation is clear, the fate of the endothelial cells retained between two stromal interfaces and their physiological role, if any, is not well understood. The aim of our study was therefore to evaluate the viability of a healthy endothelial-Descemet's membrane (EDM) graft after the insertion into a stromal pocket of a recipient donor cornea. Research corneas (n = 52) were divided into three groups: Group A, where an EDM (obtained from another cornea) with good endothelium was inserted in a stromal pocket endothelium side down; Group B, consisting of control corneas with a stromal pocket but without EDM insertion; and Group C, pre-stripped membranes resting on their stroma (not in a stromal pocket). The tissues were preserved in tissue culture medium for 21 days at 31 °C. Parameters including viability of endothelial cells, expression of tight junctions (ZO-1) and thickness were evaluated. After 21 days, all the membranes inserted within the stromal pocket of Group A survived, although an average endothelial cell loss of 30.1% (± 18.10) and a mortality of 10.2% (± 22.86) were recorded. Qualitative analysis using triple staining with Hoechst, ethidium homodimer and calcein AM confirmed the mortality. ZO-1 was expressed where the cells were present, showing good integrity of tight junctions. Group C showed an average endothelial cell loss of 1.9% (± 3.38), a mortality of 0.02% (± 0.07) and a higher expression of ZO-1. An EDM graft with endothelium facing downwards can survive in a stromal pocket for at least 3 weeks, with an overall cell mortality of 30%. Further studies are needed to evaluate the possible outcomes of the insertion of a healthy intrastromal EDMs with reverse polarity and in edematous corneas.
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Feizi S, Azari AA. Appropriate stage of Descemet membrane removal during donor preparation in deep anterior lamellar keratoplasty. Int Ophthalmol 2020; 40:1825-1830. [PMID: 32246302 DOI: 10.1007/s10792-020-01352-1] [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: 01/26/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the appropriate surgical stage for Descemet membrane (DM) removal during donor preparation in deep anterior lamellar keratoplasty (DALK). METHODS This study included 83 corneoscleral buttons that were used for DALK. The donor DM was removed randomly either before (group 1; 43 eyes) or after (group 2; 40 eyes) trephination. The time required for DM removal was recorded, and the geometric properties of cut buttons were evaluated after trephination. The intraoperative video recordings were reviewed to determine if the dissections were performed at the stroma-DM plane as it was intended. The time needed to remove the DM, the rate of correct dissection at the intended stroma-DM plane, and the roundness and precision of the donor cuts were compared between the groups. RESULTS The two groups were comparable in donor characteristics, including age, quality of the tissue, and trephination size. Time spent to remove DM was significantly shorter in group 1 (68.9 ± 48.2 s) than group 2 (117.7 ± 52.7 s, P = 0.001). DM stripping was performed incorrectly in 2 corneas (4.7%) in group 1 and in 12 corneas (30%) in group 2 (P = 0.01). No difference was found between the groups in the roundness and precision of donor button cuts. CONCLUSIONS DM removal before trephination did not detrimentally affect the geometric properties of punched donor tissues. When DM stripping was performed before trephination, the donor tissue was less traumatized and posterior graft surface was more likely to be regular; therefore, it is advisable to remove DM before trephination during donor preparation for DALK.
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Affiliation(s)
- Sepehr Feizi
- Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran, 16666, Iran.
| | - Amir A Azari
- Department of Ophthalmology, Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 St., Pasdaran Ave., Tehran, 16666, Iran
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Baenninger PB, Bodmer NS, Bachmann LM, Iselin K, Kaufmann C, Belin MW, Thiel MA. Keratoconus Characteristics Used in Randomized Trials of Surgical Interventions—A Systematic Review. Cornea 2019; 39:615-620. [DOI: 10.1097/ico.0000000000002202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Macedo JP, de Oliveira LA, Hirai F, de Sousa LB. Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus. Int J Ophthalmol 2018; 11:807-812. [PMID: 29862180 DOI: 10.18240/ijo.2018.05.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the functional and anatomic results of femtosecond laser (FSL)-assisted deep anterior lamellar keratoplasty (DALK) associated with phototherapeutic keratectomy (PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus. METHODS During the first phase of the study, an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups: in FSL group, FSL lamellar cuts were performed on two corneas and in FSL+PTK group, PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made. During the second phase of the study, a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus: group 1 (n=14 eyes) underwent FSL-assisted DALK associated with PTK and group 2 (n=12 eyes) underwent FSL-assisted DALK associated with the big-bubble technique. The main outcome measures were the postoperative visual acuity (VA) and optical coherence tomography (OCT) measurements, confocal microscopic findings, and contrast sensitivity. RESULTS In the pilot study, histopathology showed a more regular stromal bed in the FSL+PTK group. In the clinical trial, group 1 had significantly worse best spectacle-corrected VA and contrast sensitivity (P<0.05 for both comparisons). The residual stromal bed measured by OCT was significantly (P<0.05) thicker in group 1. Confocal microscopy detected opacities only at the donor-receptor interface in group 1. CONCLUSION Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.
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Affiliation(s)
- Jarbas Pereira de Macedo
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Lauro Augusto de Oliveira
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Flavio Hirai
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Luciene Barbosa de Sousa
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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Parker J, van Dijk K, Melles G. Updates in anterior lamellar keratoplasty: the state of the debates. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1224656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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