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Kaur A, Parida P, Priyadarshini SR, Mohanty A, Sahu SK, Das S. Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India. Indian J Ophthalmol 2023; 71:3166-3170. [PMID: 37602603 PMCID: PMC10565916 DOI: 10.4103/ijo.ijo_2636_22] [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: 10/09/2022] [Revised: 06/24/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011-2020) in a tertiary eye care center of eastern India. Methods A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Results Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full-thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full-thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). Conclusion With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full-thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period.
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Affiliation(s)
- Amanjot Kaur
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Priyadarsani Parida
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Amrita Mohanty
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Qureshi S, Dohlman TH. Penetrating Keratoplasty: Indications and Graft Survival by Geographic Region. Semin Ophthalmol 2023; 38:31-43. [PMID: 36527378 PMCID: PMC10084850 DOI: 10.1080/08820538.2022.2152710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022]
Abstract
Corneal transplantation, or penetrating keratoplasty (PK), is the most common form of solid-organ transplantation performed worldwide. Here, we evaluated the indications for PK and rates of transplant survival around the world by geographic region. We conducted a literature search of PubMed, MEDLINE, and Google Scholar databases and identified 155 relevant studies from 41 countries published between 1987 and 2021. The most common indications for PK were keratoconus in Europe, Africa, the Middle East, Australia, New Zealand, and Central and South America, bullous keratopathy in North America, and corneal scarring in Asia. The overall global mean graft survival rates at 1-, 2-, 3-, 5-, and 10-years were 88.6%, 81.2%, 78.9%, 72.8%, and 61.2%, respectively. Through this systematic analysis of PK by region, we hope to bring a new perspective to the corneal transplantation literature and to potentially highlight global differences and unmet needs in patient care.
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Affiliation(s)
- Sana Qureshi
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Reinprayoon U, Srihatrai P, Satitpitakul V, Puangsricharern V, Wungcharoen T, Kasetsuwan N. Survival Outcome and Prognostic Factors of Corneal Transplantation: A 15-Year Retrospective Cohort Study at King Chulalongkorn Memorial Hospital. Clin Ophthalmol 2021; 15:4189-4199. [PMID: 34703206 PMCID: PMC8536876 DOI: 10.2147/opth.s336986] [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: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate long-term survival outcomes and determine the prognostic factors of corneal transplantation performed at a tertiary referral hospital in Thailand. Design A 15-year retrospective cohort study. Materials and Methods One corneal graft per patient was selected; graft failure was defined as graft opacity due to recurrent disease or endothelial cell dysfunction. Kaplan–Meier survival analysis was performed. Median time to failure was compared using the Log rank test. Prognostic factors were identified using the Cox proportional hazards model. Results We enrolled 704 transplanted grafts. Surgical indications were optical (88.5%), therapeutic (10.2%), and tectonic (1.3%). The most common diagnoses were corneal opacity (25.3%), bullous keratopathy (15.8%), and regraft (14.8%). The overall survival rates at 1, 3, 5, and 10 years were 87.5%, 72.0%, 59.2%, and 41.7%, respectively. Univariate analysis identified age, primary diagnosis, graft size, pre-existing glaucoma, prior lens status, prior intraocular surgery, indication for surgery, donor endothelial cell density, and previous graft rejection as prognostic factors for graft failure. Multivariate analysis revealed three prognostic factors: primary diagnosis of perforation/peripheral ulceration/Mooren’s ulcer (hazard ratio [HR]=28.57; 95% confidence interval [CI], 6.32–129.16; P<0.001), active keratitis (HR=24.30; 95% CI, 5.88–100.43; P<0.001), regraft (HR=9.37; 95% CI, 2.27–38.66; P=0.002), and pseudophakic/aphakic bullous keratopathy (HR=7.97; 95% CI, 1.93–32.87; P=0.004); pre-existing glaucoma (HR=1.52; 95% CI, 1.13–2.04; P=0.006); and previous graft rejection (HR=1.95; 95% CI, 1.54–2.48; P<0.001). Conclusion Overall corneal graft survival rate was high in the first postoperative year and decreased after that. Primary diagnosis, pre-existing glaucoma, and previous graft rejection negatively influenced graft survival.
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Affiliation(s)
- Usanee Reinprayoon
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Parinya Srihatrai
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vannarut Satitpitakul
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vilavun Puangsricharern
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thitima Wungcharoen
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ngamjit Kasetsuwan
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years' experience. Int Ophthalmol 2021; 41:957-972. [PMID: 33625652 DOI: 10.1007/s10792-021-01731-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate keratoplasty outcomes in a university-based hospital. METHODS Medical records of all patients undergoing keratoplasty at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between January 1, 2006, and December 31, 2015, with a minimum follow-up period of three months were reviewed retrospectively. Indications, surgical procedures, complications and outcomes of all surgeries were collected and analyzed. MAIN OUTCOME MEASURES Graft survival and visual acuity. RESULTS Data were available for 488 grafts in the study period, including 313 optical penetrating keratoplasty (PKP), 42 therapeutic/tectonic PKPs, 72 deep anterior lamellar keratoplasty, 58 Descemet's stripping automated endothelial keratoplasty and 3 Descemet's membrane endothelial keratoplasty. A total of 389 (79.7%) grafts survived, whereas 99 (20.3%) grafts failed. The projected 1-year, 3-year and 5-year cumulative survival rates for the entire study group were 85.8%, 74.9% and 71.1%, respectively. Corneal ectasia was the commonest surgical indication accounting for 48% of the cases. The best long-term survival rates were observed in the stromal dystrophy and corneal ectasia groups. The worst survival rates were noticed in the congenital corneal opacities group. Vision improved in in 57.5% of grafted eyes, remained the same in 39.8% and deteriorated in 2.7%. Postoperative complications occurred in 36% of the grafts with rejection being the most common, and its mere occurrence increased the risk of graft failure by 20-fold. CONCLUSION The outcome of grafting in a university-based hospital can be excellent in low-risk grafts and fair to low in high-risk grafts. Our results are relatively comparable to nationally and internationally reported outcomes.
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Pluzsik MT, Tóth G, Tóth J, Matolcsy A, Langenbucher A, Kerényi Á, Nagy ZZ, Szentmáry N. Changing trends in penetrating keratoplasty indications at a tertiary eye care center in Budapest, Hungary between 2006 and 2017. Int J Ophthalmol 2020; 13:1814-1819. [PMID: 33215015 DOI: 10.18240/ijo.2020.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the changing trends in penetrating keratoplasty (PKP) indications. METHODS This retrospective study included all patients with PKP between 2006 and 2017. Patients were classified using histological diagnoses. Our groups were as the following: pseudophakic or aphakic bullous keratopathy, regraft, acute necrotizing and ulcerative keratitis, keratoconus, Fuchs' dystrophy, corneal dystrophy other than Fuchs', corneal scar, other diagnoses and failed endothelial keratoplasty graft. Additionally, two different time-periods (2006-2012 and 2013-2017) were analysed. RESULTS Totally 1721 histological analyses of 1214 patients were available for review. The diagnoses were pseudophakic or aphakic bullous keratopathy in 487 (28.3%), regraft in 443 (25.7%), acute necrotizing and ulcerative keratitis in 313 (18.2%), corneal scar in 153 (8.9%), keratoconus in 140 (8.1%). Fuchs' dystrophy in 61 (3.5%), corneal dystrophy other than Fuchs' in 46 (2.7%), other diagnoses in 44 (2.6%) and failed endothelial keratoplasty graft in 34 (2.0%) cases. From the first to the second analysed time-period, incidence of acute necrotizing and ulcerative keratitis, corneal scar, Fuchs' dystrophy increased (P≤0.032 for all) and incidence of keratoconus significantly decreased (P=0.015). CONCLUSION Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP, followed by regraft and acute necrotizing and ulcerative keratitis.
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Affiliation(s)
- Milán Tamás Pluzsik
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest 1106, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Jeannette Tóth
- 2nd Department of Pathology, Semmelweis University, Budapest 1091, Hungary
| | - András Matolcsy
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest 1085, Hungary
| | - Achim Langenbucher
- Experimental Ophthalmology, Saarland University, Homburg/Saar 66421, Germany
| | - Ágnes Kerényi
- Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest 1106, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University Homburg/Saar 66424, Germany
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6
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Pluzsik MT, Seitz B, Flockerzi FA, Langenbucher A, Tóth G, Bohle RM, Szentmáry N. Changing Trends in Penetrating Keratoplasty Indications between 2011 and 2018 - Histopathology of 2123 Corneal Buttons in a Single Center in Germany. Curr Eye Res 2020; 45:1199-1204. [PMID: 32114836 DOI: 10.1080/02713683.2020.1737716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To analyse the changing trends in penetrating keratoplasty indications between January 2011 and December 2018, at the Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. Patients and Methods: This is a retrospective review of 2123 corneal buttons of 1776 patients (1993 eyes, 56.0% males, age at the time of surgery 57.6 ± 18.7 years), who underwent penetrating keratoplasty (PKP) between January 2011 and December 2018. The classification was performed based on histological analysis and using the priority scheme of Brady et al., supplemented by a group of "failed endothelial keratoplasty grafts". Our groups were the following: pseudophakic or aphakic bullous keratopathy, regraft, failed endothelial keratoplasty graft, acute necrotizing and ulcerative keratitis, keratoconus, Fuchs' dystrophy, corneal dystrophy other than Fuchs', corneal scars and other diagnoses. Results: Between 2011 and 2018, keratoconus was the leading indication for PKP in 455 (21.5%) cases, followed by acute necrotizing and ulcerative keratitis in 384 (18.1%), regraft in 367 (17.3%), corneal scars in 350 (16.5%), pseudophakic or aphakic bullous keratopathy in 225 (10.6%), Fuchs' dystrophy in 194 (9.1%), other diagnoses in 64 (3.0%), corneal dystrophy other than Fuchs' in 52 (2.4%), and failed endothelial keratoplasty graft in 32 (1.5%) cases. Conclusions: With the introduction of posterior lamellar keratoplasty, keratoconus remains the leading PKP indication in our center with excimer laser-trephination on a routine basis. A trend towards increasing numbers can be observed regarding acute necrotizing and ulcerative keratitis patients and regrafts. However, the incidence of Fuchs' dystrophy decreased dramatically within PKP patients, with the introduction of posterior lamellar keratoplasty.
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Affiliation(s)
- Milán Tamás Pluzsik
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Bajcsy-Zsilinszky Hospital , Budapest, Hungary
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany
| | - Fidelis A Flockerzi
- Department of Pathology, Saarland University Medical Center, UKS , Homburg, Germany
| | | | - Gábor Tóth
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Semmelweis University , Budapest, Hungary
| | - Rainer M Bohle
- Department of Pathology, Saarland University Medical Center, UKS , Homburg, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, UKS , Homburg, Germany.,Department of Ophthalmology, Semmelweis University , Budapest, Hungary
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An 11-Year Review of Keratoplasty in a Tertiary Referral Center in Turkey: Changing Surgical Techniques for Similar Indications. Eye Contact Lens 2018; 43:364-370. [PMID: 27203794 DOI: 10.1097/icl.0000000000000274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Study aims to evaluate the indications and surgical techniques for corneal transplantation and to report changes in trends for preferred keratoplasty surgical techniques. METHODS Clinical records of 815 consecutive corneal transplantations between January 1, 2004 and December 31, 2014 in Haydarpasa Numune Training and Research Hospital Eye Clinic were analyzed and classified into seven broad groups according to indications. Main outcome measures were change of leading indications and trends for surgical techniques. RESULTS Leading indications for keratoplasty were keratoconus (KCN) (27.7%), bullous keratopathy (BK) (23%), postinfectious corneal scars (13.5%), regrafts (13.1%), corneal dystrophies (12.1%), and noninfectious corneal scars (5.4%). Regrafts were the only indication with a significantly increasing trend (P<0.01). Since the introduction of lamellar keratoplasty (LK) techniques including deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK), there was a significant increasing trend in number and percentage of both LK techniques (DALK; P=0.001 and P=0.007, and DSAEK; P<0.001 and P<0.001, respectively) and a significant corresponding decline in the percentage of penetrating keratoplasty (PK) (P<0.01). Similarly, DALK and DSAEK replaced PK as the preferred surgical technique for KCN and BK indications, (P=0.007 and P=0.01, respectively). Although PK was the most common surgical technique over the 11-year period (54.7%), both anterior and posterior LK techniques showed an emerging trend as the procedures of choice when indicated. CONCLUSIONS No major shift was observed in the clinical indications for corneal transplantation over the previous 11 years, except for regrafts. Lamellar keratoplasty techniques largely overtook the PK technique, but PK was still the overall preferred technique in the era when both LK techniques were used.
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Zhong W, Montana M, Santosa SM, Isjwara ID, Huang YH, Han KY, O'Neil C, Wang A, Cortina MS, de la Cruz J, Zhou Q, Rosenblatt MI, Chang JH, Azar DT. Angiogenesis and lymphangiogenesis in corneal transplantation-A review. Surv Ophthalmol 2017; 63:453-479. [PMID: 29287709 DOI: 10.1016/j.survophthal.2017.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
Corneal transplantation has been proven effective for returning the gift of sight to those affected by corneal disorders such as opacity, injury, and infections that are a leading cause of blindness. Immune privilege plays an important role in the success of corneal transplantation procedures; however, immune rejection reactions do occur, and they, in conjunction with a shortage of corneal donor tissue, continue to pose major challenges. Corneal immune privilege is important to the success of corneal transplantation and closely related to the avascular nature of the cornea. Corneal avascularity may be disrupted by the processes of angiogenesis and lymphangiogenesis, and for this reason, these phenomena have been a focus of research in recent years. Through this research, therapies addressing certain rejection reactions related to angiogenesis have been developed and implemented. Corneal donor tissue shortages also have been addressed by the development of new materials to replace the human donor cornea. These advancements, along with other improvements in the corneal transplantation procedure, have contributed to an improved success rate for corneal transplantation. We summarize recent developments and improvements in corneal transplantation, including the current understanding of angiogenesis mechanisms, the anti-angiogenic and anti-lymphangiogenic factors identified to date, and the new materials being used. Additionally, we discuss future directions for research in corneal transplantation.
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Affiliation(s)
- Wei Zhong
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China; Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Montana
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samuel M Santosa
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irene D Isjwara
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yu-Hui Huang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyu-Yeon Han
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Christopher O'Neil
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ashley Wang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Soledad Cortina
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jose de la Cruz
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Qiang Zhou
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
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Changing Indications in Penetrating Keratoplasty: A Systematic Review of 34 Years of Global Reporting. Transplantation 2017; 101:1387-1399. [PMID: 27336399 DOI: 10.1097/tp.0000000000001281] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Penetrating keratoplasty (PK) ranks among the oldest and most common kinds of human tissue transplantation. Based on the hypothesis that reported indications for PK significantly vary between global regions and over time, the present systematic review aimed to provide a thorough overview of global PK indications as reported in peer-reviewed manuscripts. METHODS A literature search of PubMed and MEDLINE was conducted to retrieve articles published from January 1980 to May 2014. Indications for PK within 7 global regions were compared using a modified classification system for PK indications and analyzed via multivariate regression. RESULTS A total of 141 publications from 37 countries were included, recording 180 865 PK cases. Postcataract surgery edema was the predominant indication in North America (28.0%) and ranked second in Europe (20.6%), Australia (21.1%), the Middle East (13.6%), Asia (15.5%), and South America (18.6%). Keratoconus was the leading indication in Europe (24.2%), Australia (33.2%), the Middle East (32.8%), Africa (32.4%), and South America (22.8%). It ranked third in North America (14.2%). Keratitis was the primary indication in Asia (32.3%). Fuchs endothelial corneal dystrophy was the fourth most common indication in North America (12.9%) and Europe (10.2%) and fifth in South America (3.8%). Multivariate analysis supported these results and revealed individual regional changes over time. CONCLUSIONS Systematic analysis reveals characteristic chronological and regional differences in reported global PK indications. Leading reported indications for PK between 1980 and 2014 were keratoconus (Europe, Australia, the Middle East, Africa, and South America), pseudophakic bullous keratopathy/aphakic bullous keratopathy (North America), and keratitis (Asia).
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Arya SK, Raj A, Bamotra RK, Bhatti A, Deswal J, Sindhu M. Indications and graft survival analysis in optical penetrating keratoplasty in a tertiary care center in North India: a 5-year study. Int Ophthalmol 2017; 38:1669-1679. [DOI: 10.1007/s10792-017-0641-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
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Alipour F, Rahimi F, Hashemian MN, Ajdarkosh Z, Roohipoor R, Mohebi M. Mini-scleral Contact Lens for Management of Poor Visual Outcomes after Intrastromal Corneal Ring Segments Implantation in Keratoconus. J Ophthalmic Vis Res 2016; 11:252-7. [PMID: 27621780 PMCID: PMC5000525 DOI: 10.4103/2008-322x.188400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the feasibility and efficacy of mini-scleral design (MSD) contact lenses to treat keratoconus patients who were unsatisfied with the results of corneal inlay. Methods: In this prospective interventional case series, 9 eyes of 6 keratoconus patients who were unsatisfied with the results of corneal inlay were fitted with MSD contact lenses. Demographic data, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher order aberrations (HOAs) were evaluated before contact lens fitting. Corrected visual acuity by placing the MSD contact lens with or without over-refraction, and HOAs were measured one hour after contact lens fitting. One month after contact lens wearing, corrected visual acuity by placing the MSD contact lens with over-refraction and possible contact lens related problems were assessed. Ocular comfort and contact lens handling problems were asked in follow-up visits. The data was analyzed using descriptive statistical tests. Results: Nine eyes of 6 patients were successfully fitted with the mini-scleral lens. Fitting was ideal in 7 eyes and acceptable in 2 eyes. Mean corrected visual acuity by placing the MSD lens without over-refraction was 0.09 (range, 0.00-0.15) LogMAR which was significantly better than the mean BSCVA of 0.38 (range, 0.2-0.6) LogMAR (P = 0.007). The mean root mean square (RMS) of third-order coma and trefoil significantly decreased after MSD contact lens fitting (P = 0.012 and P = 0.015, respectively); however, changes in the fourth-order spherical aberration were not statistically significant (P = 0.336). Conclusion: Mini-scleral contact lenses may be helpful in the management of visually unsatisfied patients after corneal inlay.
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Affiliation(s)
- Fatemeh Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Rahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Ajdarkosh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mohebi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Lin IH, Chang YS, Tseng SH, Huang YH. A comparative, retrospective, observational study of the clinical and microbiological profiles of post-penetrating keratoplasty keratitis. Sci Rep 2016; 6:32751. [PMID: 27587283 PMCID: PMC5009354 DOI: 10.1038/srep32751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/15/2016] [Indexed: 11/09/2022] Open
Abstract
Infectious keratitis after penetrating keratoplasty (PK) is a devastating condition that may result in graft failure and poor visual outcome. In this study, we retrospectively reviewed the medical records of patients who underwent PK between 2009 and 2014, and recorded those who developed infectious keratitis. We compared the predisposing factors and organisms isolated to those identified in our previous study, conducted between 1989 and 1994. The incidence of post-PK infectious keratitis decreased from 11.6% (41 out of 354 cases, 1989–1994) to 6.5% (9 out of 138 cases, 2009–2014). Graft epithelial defect and suture-related problems remained the leading two risk factors of infectious keratitis after PK. Gram-positive and Gram-negative bacterial infection decreased from 58.5% and 46.3% to 11.1% and 22.2%, respectively (P = 0.023 and P = 0.271). In contrast, fungus infection increased from 9.8% to 66.7% (P = 0.001); fungi have become the major pathogen for post-PK infectious keratitis. In conclusion, while the incidence of post-PK infectious keratitis has decreased over time, the number and frequency of fungal infections have significantly increased in the recent study period. Clinicians should be aware of the shifting trend in pathogens involved in post-PK infectious keratitis.
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Affiliation(s)
- I-Huang Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Chang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Altay Y, Burcu A, Aksoy G, Ozdemir ES, Ornek F. Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014. Clin Ophthalmol 2016; 10:1007-13. [PMID: 27330270 PMCID: PMC4898412 DOI: 10.2147/opth.s102315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. Objective The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. Methods We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2). Patients’ demographic data, indications for corneal transplantation, and the type of surgery were recorded. Results The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%), bullous keratopathy (17%), and non-herpetic corneal scar (13.3%), and between 2005 and 2014, they were keratoconus (33.8%), corneal stromal dystrophy (14.2%), and bullous keratopathy (12.7%). All the keratoplasties performed in the 1995–2004 period were penetrating keratoplasty (PKP). During the period 2005–2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. Conclusion Keratoconus was the leading indication for keratoplasty in both periods. In the 2005–2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP.
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Affiliation(s)
- Yesim Altay
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ayse Burcu
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gozde Aksoy
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Evin Singar Ozdemir
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Firdevs Ornek
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
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14
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Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye 2015; 38:54-8. [DOI: 10.1016/j.clae.2014.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
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15
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Lau LCM, Ma L, Young AL, Rong SS, Jhanji V, Brelen ME, Pang CP, Chen LJ. Association of common variants in TCF4 and PTPRG with Fuchs' corneal dystrophy: a systematic review and meta-analysis. PLoS One 2014; 9:e109142. [PMID: 25299301 PMCID: PMC4192317 DOI: 10.1371/journal.pone.0109142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/08/2014] [Indexed: 12/04/2022] Open
Abstract
TOPIC A meta-analysis of TCF4 and PTPRG gene variants in Fuchs' corneal dystrophy (FCD). CLINICAL RELEVANCE To identify novel genetic markers in patients with FCD in different ethnic populations. METHODS MEDLINE and EMBASE were searched for eligible genetic studies on TCF4 and PTPRG in FCD. Odds ratios (OR) and 95% confidence intervals (CI) of each single-nucleotide polymorphism (SNP) in allelic, dominant and recessive models were estimated using fixed-effect model if I2<50% in the test for heterogeneity, otherwise the random effects model was used. RESULTS Thirty-three records were obtained, with 8 being suitable for meta-analysis, which included five SNPs in TCF4 and two in PTPRG. There were 1610 FCD patients and 1565 controls tested for TCF4 rs613872. This SNP was strongly associated with FCD in Caucasians (P = 5.0×10-106), with the risk allele G conferring an OR of 3.95 (95% CI: 3.49-4.46). A further 4 TCF4 SNPs (rs17595731, rs2286812, rs618869 and rs9954153) were also significantly associated with FCD in Caucasians (P<10-8). However, we found no SNP associated with FCD in Chinese. In addition, there was no significant association between FCD and PTPRG. CONCLUSION TCF4 rs613872 is strongly associated with FCD in Caucasians but not in Chinese, which may suggest ethnic diversity in FCD SNP associations. SNPs in PTPRG were not associated with FCD in Caucasians or Chinese populations. Results of this meta-analysis indicate the need for larger-scale and multi-ethnic genetic studies on FCD to further explore the associated gene variants and their roles on the mechanism and genetic basis of FCD.
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Affiliation(s)
- Lawrence C M Lau
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Li Ma
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Shi Song Rong
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Marten E Brelen
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, Prince of Wales hospital, Hong Kong, China; Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
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A cornea substitute derived from fish scale: 6-month followup on rabbit model. J Ophthalmol 2014; 2014:914542. [PMID: 25089206 PMCID: PMC4096004 DOI: 10.1155/2014/914542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/09/2014] [Indexed: 01/26/2023] Open
Abstract
A fish scale-derived cornea substitute (Biocornea) is proposed as an alternative for human donor corneal tissue. We adopt a regenerative medicine approach to design a primary alternative to the use of fish scale for restoring sight by corneal replacement. Biocornea with corneal multilayer arrangement collagen was implanted to rabbits by pocket implantation. Our study demonstrated the safety and detailed morphologic and physiologic results from the 6 months of followup of rabbit model. In the peripheral Biocornea, the collagen fibrils were arranged in reticular fashion. Slit lamp examination showed that haze and an ulcer were not observed in all groups at 3 months postoperatively while all corneas with Biocornea were clear at both 3 months and 6 months postoperatively. The interface of Biocornea and stromal tissue were filled successfully and without observable immune cells at postoperative day 180. Moreover, the Biocornea was not dissolved and degenerated but remained transparent and showed no apparent fragmentation. Our study demonstrated that the Biocornea derived from fish scale as a good substitute had high biocompatibility and support function after a long-term evaluation. This revealed that the new approach of using Biocornea may yield an ideal artificial cornea substitute for long-term inlay placement.
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Lamm V, Hara H, Mammen A, Dhaliwal D, Cooper DK. Corneal blindness and xenotransplantation. Xenotransplantation 2014; 21:99-114. [PMID: 25268248 PMCID: PMC4181387 DOI: 10.1111/xen.12082] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/07/2013] [Indexed: 12/13/2022]
Abstract
Approximately 39 million people are blind worldwide, with an estimated 285 million visually impaired. The developing world shoulders 90% of the world's blindness, with 80% of causative diseases being preventable or treatable. Blindness has a major detrimental impact on the patient, community, and healthcare spending. Corneal diseases are significant causes of blindness, affecting at least 4 million people worldwide. The prevalence of corneal disease varies between parts of the world. Trachoma, for instance, is the second leading cause of blindness in Africa, after cataracts, but is rarely found today in developed nations. When preventive strategies have failed, corneal transplantation is the most effective treatment for advanced corneal disease. The major surgical techniques for corneal transplantation include penetrating keratoplasty (PK), anterior lamellar keratoplasty, and endothelial keratoplasty (EK). Indications for corneal transplantation vary between countries, with Fuchs' dystrophy being the leading indication in the USA and keratoconus in Australia. With the exception of the USA, where EK will soon overtake PK as the most common surgical procedure, PK is the overwhelming procedure of choice. Success using corneal grafts in developing nations, such as Nepal, demonstrates the feasibility of corneal transplantation on a global scale. The number of suitable corneas from deceased human donors that becomes available will never be sufficient, and so research into various alternatives, for example stem cells, amniotic membrane transplantation, synthetic and biosynthetic corneas, and xenotransplantation, is progressing. While each of these has potential, we suggest that xenotransplantation holds the greatest potential for a corneal replacement. With the increasing availability of genetically engineered pigs, pig corneas may alleviate the global shortage of corneas in the near future.
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Affiliation(s)
- Vladimir Lamm
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hidetaka Hara
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alex Mammen
- Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Deepinder Dhaliwal
- Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David K.C. Cooper
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Duman F, Kosker M, Suri K, Reddy JC, Ma JF, Hammersmith KM, Nagra PK, Rapuano CJ. Indications and outcomes of corneal transplantation in geriatric patients. Am J Ophthalmol 2013; 156:600-607.e2. [PMID: 23769195 DOI: 10.1016/j.ajo.2013.04.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/26/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients. DESIGN Retrospective case series. METHODS Data of all patients 65 years old and older who underwent corneal transplantation at Wills Eye Institute from April 2007 to January 2013, and were followed up for at least 1 year, were collected. Two hundred seventy-one eyes of 253 patients were divided into 2 groups according to the age of the patient. RESULTS Group I (65-79 years old) included 181 eyes and Group II (80 years and older) included 90 eyes. The most common indication was Fuchs endothelial dystrophy, with 78 eyes (43%) in Group I and 34 eyes (38%) in Group II. In Group I, 93 Descemet stripping endothelial keratoplasty (DSEK) (51%), 84 penetrating keratoplasty (PK) (46%), and 4 keratoprosthesis procedures(2%) were performed; in Group II, 37 DSEK (41%), 51 PK (57%), and 2 keratoprosthesis procedures (2%) were performed. Graft survival rate at last visit was 90% for Group I and 88% for Group II. Rejection occurred in 18 Group I eyes (10%) and 7 Group II eyes (8%) (P = .562). CONCLUSION Endothelial abnormalities were more common indications and keratoconus was a less common indication for surgery in the elderly. Fuchs dystrophy was the leading indication for surgery in both super-geriatric and younger geriatric patients. Graft survival rate was slightly higher in the younger geriatric age group but was not statistically significant. In the elderly, there is an increased prevalence of both glaucoma and retinal diseases that can affect the visual outcomes after corneal transplantation.
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