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Lacorzana J, Hong SC, Georges P, Petsoglou C. Patch endothelial keratoplasty for corneal perforations secondary to ocular surface disease: case series. Graefes Arch Clin Exp Ophthalmol 2024; 262:519-526. [PMID: 37594511 DOI: 10.1007/s00417-023-06194-y] [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: 02/15/2023] [Revised: 05/19/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Corneal perforation is an ophthalmic emergency. The conventional management of corneal perforation can be associated with severe complications especially in patients with ocular surface disease. Endothelial keratoplasty has been suggested as an alternative surgical technique for the management of corneal perforations. We present a case series of nine patients with corneal perforation and ocular surface disease managed with secondary patch endothelial keratoplasty. METHODS This is a retrospective case series of nine patch endothelial keratoplasties performed between 2016 and 2022 at a quaternary eye hospital in Australia. The surgical technique is similar to conventional endothelial keratoplasty except descemetorhexis was not performed. RESULTS A total of 9 cases were treated during the review period. Eight of the nine cases had an improvement in visual acuity. One case failed to achieve corneal tectonic objective. CONCLUSION Patch endothelial keratoplasty is a safe secondary procedure for the management of corneal perforations in patients with ocular surface disease.
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Affiliation(s)
- Javier Lacorzana
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia
- Department of Ophthalmology, Glaucoma Unit, Birmingham and Mindland Eye Center, Birmingham, UK
| | - Sheng Chiong Hong
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia.
| | - Pierre Georges
- New South Wales Tissue Bank, New South Wales Organ and Tissue Donation Service, Sydney, Australia
| | - Constantinos Petsoglou
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia
- New South Wales Tissue Bank, New South Wales Organ and Tissue Donation Service, Sydney, Australia
- Specialty of Ophthalmology, Faculty of Medicine, University of Sydney, Sydney, Australia
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Wajnsztajn D, Faraj LA, Sanchez-Tabernero S, Solomon A. Neurotrophic keratitis: inflammatory pathogenesis and novel therapies. Curr Opin Allergy Clin Immunol 2023; 23:520-528. [PMID: 37694830 DOI: 10.1097/aci.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Neurotrophic keratitis is a rare degenerative disease characterized by decrease or absence of corneal sensation. Neurotrophic keratitis varies from mild forms with mild epitheliopathy to severe manifestations such as corneal ulceration, melting and perforation that can lead to irreversible visual loss. The cause of neurotrophic keratitis comprises a long list of diseases, medications, congenital or genetic conditions as well as trauma. The mechanism of neurotrophic keratitis is complex and multifactorial and its understanding is crucial to better address the treatment strategies. We aimed to review neurotrophic keratitis pathology, mechanisms and management. RECENT FINDINGS Corneal nerves are critical for the homeostasis of a healthy ocular surface. The lack of nerve-derived neuromediators and corneal-released neuropeptides, neuro-trophins and neurotrophic factors in neurotrophic keratitis leads to a decrease in trophic supply to corneal cells in addition to a decrease in afferent signaling to the brain. This results in pathological tear secretion, decreased blinking rate, corneal healing along with ocular surface and corneal inflammation. Lately, nerve growth factor in special gained emphasis as a treatment strategy targeting the disease mechanism rather than its manifestations. Other therapies, including surgical interventions, are in the pipeline of neurotrophic keratitis management. However, there are still no proper therapeutic guidelines and neurotrophic keratitis treatment remains challenging. SUMMARY Neurotrophic keratitis may have a devastating outcome and treatment is still challenging. Understanding the disease pathology may assist in the development of new treatment strategies. Prompt disease recognition and immediate intervention are key factors to promote corneal healing and avoid further deterioration.
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Affiliation(s)
- Denise Wajnsztajn
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lana A Faraj
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Abraham Solomon
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Xiao G, Ben H, Gu S, Hong J. DALK combined intralamellar tectonic patch graft: an alternative approach to treat frank corneal perforation. BMC Ophthalmol 2023; 23:436. [PMID: 37891524 PMCID: PMC10605785 DOI: 10.1186/s12886-023-03179-7] [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: 08/26/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Deep anterior lamellar keratoplasty (DALK) has gained popularity in cases of corneal thinning and leaking descemetocele. In this study, we introduced an intralamellar tectonic patch graft in addition to conventional DALK procedures to treat frank cornea perforation. METHODS This retrospective case series included 13 patients (13 eyes) with frank corneal perforations who underwent DALK combined with intralamellar tectonic patch graft between December 2015 and December 2021. In addition to the standard DALK procedure, the perforation site was repaired with an extra intralamellar tectonic patch graft. The collected data included patient demographics, aetiology, size and location of the corneal perforation, visual acuity, surgical details, and postoperative complications. RESULTS Seven patients underwent autologous intralamellar patch grafts, whereas six received allogeneic ones. Anatomical success was achieved in all patients. The mean postoperative follow-up was 33.31 ± 25.96 months (6-73 months). The postoperative visual acuity (0.90 ± 0.65 logMAR) was significantly improved (P = 0.003) compared to the preoperative score (1.74 ± 0.83 logMAR). Best corrected visual acuity (BCVA) improved in 12 eyes (92.3%). The mean endothelial cell density was 2028 ± 463 cells/mm2, 6-12 months postoperatively. There was no recurrence of perforation, and the anterior lamellar graft remained transparent in 12 patients (92.3%). Postoperative complications included epithelial defects (23.1%), ocular hypertension (15.4%), and cataract (7.7%). CONCLUSIONS DALK combined with intralamellar tectonic patch graft may serve as a secure and effective alternative in treating frank corneal perforation, with reduced complications compared to conventional penetrating keratoplasty.
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Affiliation(s)
- Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Hanzhi Ben
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Shaofeng Gu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
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Fu L, Jones SM. Tectonic mini-Descemet stripping endothelial keratoplasty (mini-DSEK) in the management of corneal perforation secondary to pediatric blepharokerato conjunctivitis. J AAPOS 2023; 27:45-47. [PMID: 36529452 DOI: 10.1016/j.jaapos.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
Blepharokeratoconjunctivitis (BKC) in children can have a broad clinical spectrum. Corneal involvement, including perforation, can occur in severe cases. Management aims to restore anatomical integrity and preserve visual function. We report the outcome of a novel technique, tectonic mini-Descemet stripping endothelial keratoplasty (mini-DSEK), to treat a corneal perforation secondary to BKC in a 14-year-old boy after failure to respond to cyanoacrylate glue application and multilayer amniotic membrane patch grafting. On follow-up 8 months postoperatively, the perforation remained sealed, and visual acuity was preserved. The major advantages of this technique are the avoidance of suture-related complications, reduced risk of immunological rejection, minimized postoperative refractive error, and rapid visual rehabilitation.
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Affiliation(s)
- Lanxing Fu
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sophie M Jones
- King's College Hospital NHS Foundation Trust, London, United Kingdom.
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Roberts HW, Davidson M, Thaung C, Myerscough J. Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis. Cornea 2022; 41:802-805. [PMID: 34935659 DOI: 10.1097/ico.0000000000002966] [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: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty. METHODS The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique. RESULTS The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9. CONCLUSIONS This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty.
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Affiliation(s)
- Harry W Roberts
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Max Davidson
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | | | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
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Roberts HW, Gunasekera CD, Law EM, Seifelnasr M, Giannaccare G, Busin M, Myerscough J. Sutureless Tectonic Mini-Descemet's Stripping Automated Endothelial Keratoplasty ("mini-DSAEK") for the management of corneal perforations. Eur J Ophthalmol 2021; 32:2133-2140. [PMID: 34657450 DOI: 10.1177/11206721211050034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the outcomes of a new technique, pull-through sutureless 'mini-DSAEK', to manage corneal perforations secondary to different aetiologies including trauma, neurotrophic ulcer following penetrating keratoplasty (PK), herpes simplex keratitis and microbial keratitis. METHODS In this retrospective case series, we report the clinical outcomes of five cases of sutureless tectonic mini-DSAEK performed in patients presenting with large corneal perforations to Southend University Hospital between November 2019 and October 2020. One corneal perforation was sufficiently peripheral for the tectonic mini-DSAEK graft to be successfully positioned outside of the central visual axis. Four corneal perforations were central or paracentral for which the tectonic grafts involved the visual axis. RESULTS Anterior chambers remained deep and formed with no evidence of leak in all subsequent follow ups in all patients representing 100% tectonic success. All tectonic grafts remained attached except one partially detached graft. One patient underwent uneventful phacoemulsification with intraocular lens implant 8 months after the primary intervention with excellent visual outcome. Two patients underwent two-piece mushroom PK and one patient underwent triple procedure (cataract extraction + intraocular lens + PK) for visual rehabilitation 2-6 months after the primary intervention with good visual outcome. CONCLUSION Sutureless tectonic pull-through mini-DSAEK is a useful technique in the management of corneal perforations, with a number of advantages compared with conventional techniques.
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Affiliation(s)
- Harry W Roberts
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK
| | | | - Elizabeth M Law
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK
| | - Mohamed Seifelnasr
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK.,Department of Ophthalmology, 54562Alexandria University, Alexandria, Egypt
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Massimo Busin
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Morphology, Surgery and Experimental Medicine, Ferrara, Italy
| | - James Myerscough
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK.,Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
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