1
|
Corneal Optical Densitometry in the Evaluation of 2-Year Graft Function Following Endothelial Keratoplasty. J Clin Med 2023; 12:jcm12041552. [PMID: 36836087 PMCID: PMC9963363 DOI: 10.3390/jcm12041552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/27/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
This study aimed to assess clinical application of the Scheimpflug corneal tomography for objective evaluation of corneal optical density in eyes undergoing Descemet's stripping endothelial keratoplasty (DSEK). In this prospective study, 39 pseudophakic eyes with bullous keratopathy were enrolled. All eyes underwent primary DSEK. Ophthalmic examination included best corrected visual acuity (BCVA) measurement, biomicroscopy, Scheimpflug tomography, pachymetry, and endothelial cell count. All measurements were taken preoperatively and within a 2-year follow-up period. Gradual BCVA improvement was observed in all patients. After two years, the mean and median BCVA values were 0.18 logMAR. A decrease in central corneal thickness was noted only during the first 3 months postoperatively and was followed by a gradual increase. Corneal densitometry decreased constantly and most significantly in the first 3 months postoperatively. The consecutive decrease in endothelial cell count of the transplanted cornea was most significant during the first 6 months postoperatively. Six months postoperatively, the strongest correlation (Spearman's r = -0.41) with BCVA was found for densitometry. This tendency was maintained throughout the entire follow-up period. Corneal densitometry is applicable for objective monitoring of early and late outcomes of endothelial keratoplasty, showing a higher correlation with visual acuity than pachymetry and endothelial cell density.
Collapse
|
2
|
Arora R, Gupta I, Sahu J, Vishwanath S, Gupta P, Jain P. Corneal aberrations, densitometry on scheimpflug imaging, and visual acuity after deep anterior lamellar keratoplasty. Eur J Ophthalmol 2022; 33:11206721221128863. [PMID: 36172635 DOI: 10.1177/11206721221128863] [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: 11/17/2022]
Abstract
PURPOSE To evaluate visual acuity, corneal aberrations, and densitometry post deep anterior lamellar keratoplasty (DALK). METHODS Twenty-five eyes of 25 patients who underwent DALK for corneal stromal diseases with normal endothelium were enrolled in a prospective interventional study. Evaluation for corneal aberrations and densitometry postoperatively was performed using Scheimpflug imaging at 6 months. Anterior Segment Optical Coherence Tomography (ASOCT) was done for host-graft morphology. Correlation analysis of postoperative best-corrected visual acuity with corneal aberrations and corneal densitometry (CD) was performed. RESULTS Big bubble deep anterior lamellar keratoplasty (BB-DALK) was successful in 18 patients, while 7 eyes underwent manual dissection due to failed BB (Big Bubble) technique. The mean BSCVA was 1.35 ± 0.46 logMAR units pre-operatively which improved to 0.36 ± 0.19 logMAR units post DALK at 6 months (P < 0.001). The mean Root Mean Square (RMS) (μm) of the magnitude of total corneal aberrations, HOA and LOA from central 6mm zone of cornea were 14.6 ± 9.2, 4.7 ± 2.9, and 13.8 ± 8.8, respectively. The mean anterior (120μm), central and posterior corneal (60μm) densitometry in 0-2mm zone were 25.8 ± 7.7 GSU, 18.7 ± 4.16 GSU and 10.09 ± 3.9 GSU respectively. A statistically significant correlation of postoperative residual stromal bed thickness, total corneal HOA, LOA, total corneal aberrations, HOA front and posterior corneal densitometry (0-2mm zone) with postoperative BSCVA was found. CONCLUSION Though there is a significant improvement in BSCVA after DALK, the quality of vision in terms of aberrometry and densitometry is suboptimal, especially in cases undergoing manual DALK compared to those undergoing big bubble formation.
Collapse
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Isha Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Jigyasa Sahu
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shweta Vishwanath
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Palak Gupta
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Parul Jain
- Department of Ophthalmology (76300Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
3
|
Tavakkoli F, Damala M, Koduri MA, Gangadharan A, Rai AK, Dash D, Basu S, Singh V. Transcriptomic Profiling of Human Limbus-Derived Stromal/Mesenchymal Stem Cells-Novel Mechanistic Insights into the Pathways Involved in Corneal Wound Healing. Int J Mol Sci 2022; 23:ijms23158226. [PMID: 35897793 PMCID: PMC9368612 DOI: 10.3390/ijms23158226] [Citation(s) in RCA: 4] [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: 06/21/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 01/27/2023] Open
Abstract
Limbus-derived stromal/mesenchymal stem cells (LMSCs) are vital for corneal homeostasis and wound healing. However, despite multiple pre-clinical and clinical studies reporting the potency of LMSCs in avoiding inflammation and scarring during corneal wound healing, the molecular basis for the ability of LMSCs remains unknown. This study aimed to uncover the factors and pathways involved in LMSC-mediated corneal wound healing by employing RNA-Sequencing (RNA-Seq) in human LMSCs for the first time. We characterized the cultured LMSCs at the stages of initiation (LMSC−P0) and pure population (LMSC−P3) and subjected them to RNA-Seq to identify the differentially expressed genes (DEGs) in comparison to native limbus and cornea, and scleral tissues. Of the 28,000 genes detected, 7800 DEGs were subjected to pathway-specific enrichment Gene Ontology (GO) analysis. These DEGs were involved in Wnt, TGF-β signaling pathways, and 16 other biological processes, including apoptosis, cell motility, tissue remodeling, and stem cell maintenance, etc. Two hundred fifty-four genes were related to wound healing pathways. COL5A1 (11.81 ± 0.48) and TIMP1 (20.44 ± 0.94) genes were exclusively up-regulated in LMSC−P3. Our findings provide new insights involved in LMSC-mediated corneal wound healing.
Collapse
Affiliation(s)
- Fatemeh Tavakkoli
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India; (F.T.); (M.D.); (M.A.K.); (S.B.)
- Center for Genetic Disorders, Banaras Hindu University, Varanasi 221005, India;
| | - Mukesh Damala
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India; (F.T.); (M.D.); (M.A.K.); (S.B.)
- School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Madhuri Amulya Koduri
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India; (F.T.); (M.D.); (M.A.K.); (S.B.)
- Manipal Academy of Higher Education, Manipal 576104, India
| | - Abhilash Gangadharan
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road Campus, New Delhi 110025, India; (A.G.); (D.D.)
| | - Amit K. Rai
- Center for Genetic Disorders, Banaras Hindu University, Varanasi 221005, India;
| | - Debasis Dash
- CSIR-Institute of Genomics and Integrative Biology, Mathura Road Campus, New Delhi 110025, India; (A.G.); (D.D.)
| | - Sayan Basu
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India; (F.T.); (M.D.); (M.A.K.); (S.B.)
- Center for Ocular Regeneration (CORE), Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India
| | - Vivek Singh
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India; (F.T.); (M.D.); (M.A.K.); (S.B.)
- Center for Ocular Regeneration (CORE), Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India
- Correspondence: ; Tel.: +91-40-6810-2286
| |
Collapse
|
4
|
Hashemi H, Aghamirsalim M, Shahhoseini S, Moghaddasi A, Asgari S. SMILE after DALK to reduce residual refraction: two-year results. Int Ophthalmol 2022; 42:3803-3812. [PMID: 35776392 DOI: 10.1007/s10792-022-02400-8] [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: 09/12/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the two-year results of small incision lenticule extraction (SMILE) for correcting post-keratoplasty myopia and myopic astigmatism. METHODS In this case-series study, 10 eyes of 10 patients with a 6- to 10-year history of successful deep lamellar keratoplasty (DALK) underwent SMILE using the VisuMax laser platform. Ophthalmologic examinations and visual acuity and refraction measurement were taken pre- and 1, 3, 6, 12, and 24 months postoperatively. The Pentacam and Sirius imaging were done in the first and last follow-up sessions. RESULTS The mean age of the patients was 39.60 ± 7.86 years. Six subjects were male. Two years after SMILE, the mean improvement in UDVA and CDVA was 3.60 ± 1.84 (P < 0.001) and 1.60 ± 2.91 (P = 0.231) LogMAR, respectively. The mean decrease in spherical equivalent, spherical error, and cylinder power was 1.92 ± 1.96 diopter (D) (P = 0.013), 0.70 ± 3.05D (P = 0.213), and 2.42 ± 2.91D (P = 0.024), respectively. The vector mean target-induced astigmatism, surgical-induced astigmatism, and difference vector were 1.30D@44˚, 1.11D@24˚, and 0.86D@73˚, respectively. Two years after SMILE, vertical coma, horizontal coma, and spherical aberration increased by 0.44 ± 0.51, 0.23 ± 0.32, and 0.02 ± 0.16 µm, respectively, (all P > 0.05) while trefoil reduced by 0.29 ± 0.75 µm (P = 0.428). CONCLUSION SMILE can be an effective procedure for reducing refraction and astigmatism after DALK in patients with moderate myopia and moderate to severe astigmatism and improves the visual acuity in these patients. Axis rotation during surgery may result in under-correction of astigmatism. Refinement of SMILE treatment nomogram for post-DALK cases seems necessary.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
| | | | - Saied Shahhoseini
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Alireza Moghaddasi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| |
Collapse
|
5
|
Arora R, Gupta P, Sahu J, Jain P, Vishwanath S, Shroff R. Analysis of Corneal Scheimpflug Densitometry and Ocular Wavefront Aberrations Post Descemet Stripping Automated Endothelial Keratoplasty. Eye Contact Lens 2022; 48:242-249. [PMID: 34860724 DOI: 10.1097/icl.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity. METHODS Twenty-seven eyes of 25 patients with nonresolving corneal edema for more than 3 months as a result of Fuchs endothelial corneal dystrophy, pseudophakic bullous keratopathy, or secondary endothelial dysfunction were enrolled in a prospective interventional study and underwent DSAEK. Postoperative evaluation for corneal aberrations, including Higher order aberrations (HOAs) and corneal densitometry (CD), was performed using anterior-segment optical coherence tomography (Avanti RTvue XR; Optovue) and Scheimpflug imaging (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany) at 6 months. A correlation analysis of corneal aberrations, including HOAs and CD, with postoperative best-corrected visual acuity at 6 months was performed. RESULTS Mean best-corrected visual acuity (BCVA) improved from 1.67±0.53 log of minimum angle of resolution (logMAR) to 0.2±0.22 logMAR post DSAEK at 6 months (P≤0.0001). At 6 months, mean root-mean-square (RMS) total corneal aberrations (includes HOA and low-order aberration [LOA]), RMS total HOA, and RMS LOA of the central 6-mm zone were 4.99±2.64, 1.80±0.9, and 4.55±2.64, respectively. The mean corneal densitometry from anterior, central, and posterior zones were 39.12±12.77, 23.9±7.2, and 13.54±2.04 gray scale units, respectively. Total anterior aberrations (r=0.051; P=0.006), anterior LOA (r=0.049; P=0.009), total corneal aberrations (r=0.051; P=0.001), total HOAs (r=0.095; P=0.057) and LOAs (r=0.050; P=0.002), and total CD from 0 to 2 mm (r=0.010; P=0.038) and 2 to 6 mm (r=0.014; P=0.018) showed a significant inverse correlation with postoperative BCVA. CONCLUSION There was an inverse relationship between post DSAEK BCVA and total corneal HOAs and full-thickness densitometry at 6 months. Scheimpflug imaging with added tools for corneal aberration and densitometry analysis gives further insight into the suboptimal vision achieved despite transparent corneas post DSAEK.
Collapse
Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre) (R.A., P.G., J.S., P.J., S.V.), Maulana Azad Medical College, New Delhi, India; and Cornea and Refractive Services (R.S.), Shroff Eye Centre, New Delhi, India
| | | | | | | | | | | |
Collapse
|
6
|
Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
Collapse
Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
| |
Collapse
|
7
|
Yoshida Y, Ono K, Tano T, Hiratsuka Y, Otani K, Sekiguchi M, Konno S, Kikuchi S, Yamada M, Fukuhara S, Murakami A. Corneal Eccentricity in a Rural Japanese Population: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). Ophthalmic Epidemiol 2021; 29:531-536. [PMID: 34427161 DOI: 10.1080/09286586.2021.1968004] [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: 10/20/2022]
Abstract
PURPOSE To determine normal corneal eccentricity in a rural Japanese population and to examine factors associated with eccentricity value. METHODS This used data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) project between 2009 and 2012. Residents of Minamiaizu and Tadami in Fukushima, Japan, who were aged 40 years or over, were invited for a comprehensive eye examination. For 1371 patients with no history of internal eye surgery, corneal eccentricity was measured using a Pentacam. RESULTS Of 1371 people recruited to the study, 1215 (1215 eyes) met the inclusion criteria. The overall mean eccentricity was 0.46 (SD = 0.18; range, -0.85 to 0.88). Corneal eccentricity was significantly associated with age, spherical equivalent, pupil diameter, anterior chamber angle, anterior chamber volume, and central corneal thickness, but not with gender or body mass index. CONCLUSIONS In this study, the normal cornea in this Japanese population was prolate. Corneal eccentricity was likely to decrease with increasing age. Also, spherical equivalent and other anterior segment parameters had an influence on corneal eccentricity. Corneal eccentricity measurements might be helpful in the diagnosis of corneal diseases and in calculations for intraocular lens implantation and corneal refractive surgery.
Collapse
Affiliation(s)
- Yuto Yoshida
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Koichi Ono
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Takatoshi Tano
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masakazu Yamada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemoilogy, Department of Community Medicine, Kyoto University, Graduate School of Medicine, Tokyo, Japan.,Shirakawa Star in General Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Peng WY, Tang ZM, Lian XF, Zhou SY. Comparing the efficacy and safety of femtosecond laser-assisted vs conventional penetrating keratoplasty: a meta-analysis of comparative studies. Int Ophthalmol 2021; 41:2913-2923. [PMID: 33860436 DOI: 10.1007/s10792-021-01826-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the safety and efficacy of femtosecond laser-assisted penetrating keratoplasty (FLAK) versus conventional penetrating keratoplasty (CPK). METHODS A literature search of PubMed, Cochrane, Embase, Web of Science, and Clinicaltrials.gov was conducted for comparative studies published from January 2007 to October 2019. Studies that involved both FLAK and CPK groups and reported on the relevant efficacy and/or safety parameters were included. The Newcastle-Ottawa quality assessment scale was used to analyse the methodological quality of these studies. Further, weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. RESULTS From the screened articles, a total of 1991 eyes from nine comparative studies were included. FLAK was not statistically superior for twelve-month postoperative best corrected visual acuity (WMD = - 0.06; 95% CI [- 0.16, 0.04]; P = 0.22), corneal astigmatism (WMD = - 0.81; 95% CI [- 1.63, 0.01]; P = 0.05) or six-month postoperative uncorrected visual acuity (WMD = - 0.11; 95% CI [- 0.27, 0.06]; P = 0.21). There were no significant differences in corneal graft rejection rate and the graft failure between FLAK and CPK at twelve months postoperative. However, best-corrected visual acuity (BCVA) and corneal astigmatism corrected with FLAK were better than those with CPK six months postoperative after elimination of data heterogeneity. CONCLUSION Visual outcomes improvement in FLAK was better than that in CPK at six months postoperative, but not twelve months postoperative. This review recommends selecting a technique based on patients' work demands and economic burdens.
Collapse
Affiliation(s)
- Wen-Yan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Zhi-Ming Tang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiu-Fen Lian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Shi-You Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
| |
Collapse
|
9
|
Castellucci M, Novara C, Casuccio A, Cillino G, Giordano C, Failla V, Bonfiglio V, Vadalà M, Cillino S. Bilateral Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty vs. Bilateral Penetrating Keratoplasty in Fuchs' Dystrophy: Corneal Higher-Order Aberrations, Contrast Sensitivity and Quality of Life. ACTA ACUST UNITED AC 2021; 57:medicina57020133. [PMID: 33546152 PMCID: PMC7913208 DOI: 10.3390/medicina57020133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs' endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, p < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes.
Collapse
Affiliation(s)
- Massimo Castellucci
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Costanza Novara
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Alessandra Casuccio
- Department of Health Promotion, Mother Child Care, Internal Medicine and of Excellence, University of Palermo, 90127 Palermo, Italy;
| | - Giovannni Cillino
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Carla Giordano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Section of Endocrinology, Diabetology and Metabolism, University of Palermo, 90127 Palermo, Italy;
| | - Valentina Failla
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Vincenza Bonfiglio
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Maria Vadalà
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Salvatore Cillino
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
- Correspondence: ; Tel.: +39-0916-553-901; Fax: +39-091-342-770
| |
Collapse
|
10
|
Song Y, Zhang J, Pan Z. Systematic Review and Meta-Analysis of Clinical Outcomes of Penetrating Keratoplasty Versus Deep Anterior Lamellar Keratoplasty for Keratoconus. EXP CLIN TRANSPLANT 2020; 18:417-428. [DOI: 10.6002/ect.2019.0123] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
11
|
Duggan MJ, Rose-Nussbaumer J, Lin CC, Austin A, Labadzinzki PC, Chamberlain WD. Corneal Higher-Order Aberrations in Descemet Membrane Endothelial Keratoplasty versus Ultrathin DSAEK in the Descemet Endothelial Thickness Comparison Trial: A Randomized Clinical Trial. Ophthalmology 2019; 126:946-957. [PMID: 30776384 DOI: 10.1016/j.ophtha.2019.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare corneal higher-order aberrations (HOA) after ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). DESIGN Patient- and outcome-masked randomized controlled clinical trial. PARTICIPANTS Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were good candidates for DMEK or ultrathin DSAEK. METHODS Corneal anterior and posterior surface HOA were measured with Scheimpflug imaging before surgery and at 3, 6, and 12 months after surgery. HOA after ultrathin DSAEK and DMEK were compared; correlation was performed between best spectacle-corrected visual acuity (BSCVA) and HOA at each time point. MAIN OUTCOME MEASURES Higher-order aberrations of the anterior and posterior cornea, expressed as the root mean square deviation from a best fit sphere reference surface. RESULTS At 3, 6, and 12 months after surgery, the posterior corneal surface had significantly less coma (P ≤ 0.003) and total HOA (P ≤ 0.001) in DMEK compared with ultrathin DSAEK (4.0- and 6.0-mm OZ). Posterior trefoil (P ≤ 0.034), secondary astigmatism (P ≤ 0.042), and tetrafoil (P ≤ 0.045) were lower in DMEK than ultrathin DSAEK at 3, 6, or 12 months (either 4.0- or 6.0-mm OZ). There were no significant differences in anterior surface HOA between DMEK and ultrathin DSAEK at any post-surgical time. Compared with baseline, total posterior HOA was increased (P ≤ 0.036) in ultrathin DSAEK at 3, 6, and 12 months, in contrast to DMEK, where it was decreased (P ≤ 0.044) at 6 and 12 months (4.0- or 6.0-mm OZ, or both). At 6 and 12 months, posterior corneal total HOA correlated with BSCVA (ρ ≤ 0.635, P ≤ 0.001; 4.0- and 6.0-mm OZ). There were no moderate or strong correlations between anterior or combined corneal surface HOA at any time point after surgery. CONCLUSIONS Descemet membrane endothelial keratoplasty results in less posterior corneal HOA compared with ultrathin DSAEK. Descemet membrane endothelial keratoplasty decreases and ultrathin DSAEK increases posterior corneal HOA compared with presurgical values. Total posterior corneal HOA correlates with 6- and 12-month postoperative visual acuity and may account for the better visual acuity observed after DMEK.
Collapse
Affiliation(s)
- Matthew J Duggan
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Jennifer Rose-Nussbaumer
- Francis I. Procter Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Charles C Lin
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Ariana Austin
- Francis I. Procter Foundation, University of California, San Francisco, San Francisco, California
| | | | | |
Collapse
|
12
|
Garrido C, Cardona G, Güell JL, Pujol J. Visual outcome of penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty. JOURNAL OF OPTOMETRY 2018; 11:174-181. [PMID: 29146479 PMCID: PMC6039585 DOI: 10.1016/j.optom.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/12/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE A single-center, cross-sectional study was designed to assess and compare objective and subjective quality of vision of patients intervened with penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS Forty-six patients previously intervened with PK (22 eyes), DALK (7 eyes) and DMEK (17 eyes) were recruited. Visual evaluation included spherical and cylindrical refraction, distance corrected visual acuity (DCVA), photopic contrast sensitivity (CS), optical quality, measured with the HD Analyzer (objective scattering index [OSI], MTF cut-off and Strehl ratio), and ocular and corneal aberrometry, measured with the KR-1W Wavefront Analyzer. RESULTS Statistically significant between-group differences were found in age (p=0.006, DMEK patients were older) and time since surgery (p<0.001, longest time for PK patients). No statistically significant differences were found in DCVA between the techniques. Between-group differences were encountered in CS at 12 (p=0.007) and 18 (p<0.001) cycles per degree, with DMEK and DALK obtaining the best and worst outcomes, respectively. Differences in optical quality were found between the techniques (OSI, p=0.004; MTF cut-off, p=0.048; Strehl ratio p=0.022), with DMEK displaying the best outcomes. Highest and lowest values in ocular and corneal aberrations were for DALK and DMEK patients, respectively. Between-group differences were found in corneal astigmatism (p<0.001; -3.31±2.00 D in PK; -2.68±0.94 D in DALK; -1.09±0.62 D in DMEK). CONCLUSION Overall, DMEK proved superior over PK and DALK in terms of quality of vision, with PK offering slightly better outcomes than DALK in most visual function parameters under evaluation.
Collapse
Affiliation(s)
- Clàudia Garrido
- Refractive and Optometry Department, Instituto de Microcirugía Ocular, Barcelona, Spain
| | - Genís Cardona
- Department of Optics and Optometry, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain.
| | - Josep L Güell
- The Cornea, Cataract and Refractive Surgery Department, Instituto de Microcirugía Ocular, Barcelona, Spain; Department of Ophthalmology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Pujol
- Department of Optics and Optometry, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain; Centre for Sensors, Instruments and Systems Development, Universitat Politècnica de Catalunya · BarcelonaTech, Terrassa, Spain
| |
Collapse
|
13
|
|
14
|
Van den Bogerd B, Dhubhghaill SN, Koppen C, Tassignon MJ, Zakaria N. A review of the evidence for in vivo corneal endothelial regeneration. Surv Ophthalmol 2017; 63:149-165. [PMID: 28782549 DOI: 10.1016/j.survophthal.2017.07.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 12/13/2022]
Abstract
Human corneal endothelium has long been thought to be a nonmitotic cell layer with no endogenous reparative potential. Pathologies that damage endothelial function result in corneal decompensation and, if untreated, blindness. The mainstay of treatment involves partial or complete corneal replacement, amounting to 40% of all corneal transplants performed worldwide. We summarize the case reports describing complications postoperatively in the form of (sub)total graft detachment and those resulting in postoperative bare stroma. Complications during cataract and glaucoma surgeries leading to an uncovered posterior cornea are also included. We discuss the newer treatment strategies that are alternatives for current Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty, including partial grafts and stripping of the diseased cell layer. In more than half of the cases reviewed, corneal transparency returned despite incomplete or no corneal endothelial cell transplantation. We question the existing paradigm concerning corneal endothelial wound healing in vivo. The data support further clinical study to determine the safety of simple descemethorexis in central endothelial pathologies, such as Fuchs endothelial corneal dystrophy, where presence of healthy peripheral cells may allow successful corneal recompensation without the need for donor cells.
Collapse
Affiliation(s)
- Bert Van den Bogerd
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sorcha Ní Dhubhghaill
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Carina Koppen
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Marie-José Tassignon
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Nadia Zakaria
- Ophthalmology, Visual Optics and Visual Rehabilitation, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium.
| |
Collapse
|
15
|
Descemet stripping automated endothelial keratoplasty versus descemet membrane endothelial keratoplasty: a meta-analysis. Int Ophthalmol 2017; 38:897-905. [PMID: 28417337 DOI: 10.1007/s10792-017-0533-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/10/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of descemet stripping automated endothelial keratoplasty (DSAEK) compared with descemet membrane endothelial keratoplasty (DMEK). METHODS Databases including PubMed, EMBASE, and Cochrane Library were searched to find studies that compared DSAEK and DMEK outcomes. Efficacy parameters were the postoperative best-corrected visual acuity (BCVA) and spherical equivalent (SE). Safety parameters were postoperative endothelial cell loss (ECL), air injection (rebubbling), graft failure, graft rejection, and high intraocular pressure (IOP). Results from last visit were pooled for the analyses because the follow-up ranged from 3 to 24 months. RESULTS A total of 7 trials including 433 eyes were selected for this meta-analysis. BCVA was reported in all 7 studies, ECL% and rebubbling rate were reported in 6, and the remaining outcomes were reported in only 3 or 2 studies. Postoperative logMAR BCVA was significantly better for DMEK than that for DSAEK (P < 0.00001). More patients achieved the postoperative BCVA ≥ 20/25 and 20/20 in DMEK group than that in DSAEK (P > 0.001), whereas the proportion of patients whose postoperative BCVA ≥ 20/40 and the amount of SE did not differ statistically (P = 0.32 and P = 0.50, respectively). The DSAEK group has a significantly lower frequency of rebubbling than the DMEK group (P < 0.0001). The postoperative ECL%, graft failure, graft rejection, and high IOP were comparable between the 2 groups (all P values >0.05). CONCLUSIONS Our meta-analysis suggests that DMEK provided better visual outcomes with similar safety when compared to DSAEK. Given the limited sample size, further investigations are needed to validate these findings.
Collapse
|
16
|
Nielsen E, Ivarsen A, Kristensen S, Hjortdal J. Fuchs' endothelial corneal dystrophy: a controlled prospective study on visual recovery after endothelial keratoplasty. Acta Ophthalmol 2016; 94:780-787. [PMID: 27273977 DOI: 10.1111/aos.13126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/14/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the determining factors of vision and subjective outcome after Descemet's stripping automated endothelial keratoplasty (DSAEK) for Fuchs' endothelial dystrophy (FECD). METHODS In a prospective study, 41 FECD patients who received DSAEK were compared to 40 cataract patients with normal corneas who received cataract surgery (control group). Subjects were recruited between March 2013 and July 2014. Observational procedures included the following: best-corrected visual acuity (BCVA), contrast sensitivity (CS), Catquest-9SF questionnaire, Scheimpflug tomography and anterior OCT. Examinations were carried out before surgery and at 3-, 6- and 12-month follow-up. Main outcome measures were associations between corneal optics and visual parameters, as well as subjective improvement (Catquest-9SF effect size) RESULTS: Best-corrected visual acuity (BCVA) negatively correlated with anterior higher-order aberrations (HOA's) (p < 0.001) and central corneal thickness (p = 0.001). Contrast sensitivity (CS) was negatively correlated with anterior HOA's (p = 0.002) and positively correlated with posterior densitometry (p = 0.008). Catquest-9SF effect size was 1.32 (CI: 1.0-1.6) in the control group, 1.84 (CI: 1.4-2.3) in FECD patients who received phacoemulsification and intra-ocular lens implantation in combination with DSAEK (n = 26) and 1.37 (CI: 0.6-2.1) in pseudophakic FECD patients who received DSAEK (n = 15). CONCLUSIONS DSAEK surgery leads to considerable improvement in patient-reported outcome in FECD patients. There was a strong correlation between anterior HOA's and vision after DSAEK, suggesting that anterior corneal pathology constitutes the major limitation for visual recovery after DSAEK.
Collapse
Affiliation(s)
- Esben Nielsen
- Department of Ophthalmology; Aarhus University Hospital; Aarhus Denmark
| | - Anders Ivarsen
- Department of Ophthalmology; Aarhus University Hospital; Aarhus Denmark
| | - Simon Kristensen
- Department of Public Health; Aarhus University Hospital; Aarhus Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology; Aarhus University Hospital; Aarhus Denmark
| |
Collapse
|
17
|
Nielsen E. Fuchs' endothelial corneal dystrophy: pathology and treatment outcome. Acta Ophthalmol 2016. [DOI: 10.1111/aos.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Esben Nielsen
- Department of Health; Aarhus University; Aarhus Denmark
- Department of Ophthalmology; Aarhus University Hospital; Denmark
| |
Collapse
|
18
|
Turnbull AMJ, Tsatsos M, Hossain PN, Anderson DF. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol 2015; 61:257-71. [PMID: 26708363 DOI: 10.1016/j.survophthal.2015.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
Endothelial keratoplasty is now favored over full-thickness penetrating keratoplasty for corneal decompensation secondary to endothelial dysfunction. Although endothelial keratoplasty has evolved as surgeons strive to improve outcomes, fewer patients than expected achieve best corrected visual acuity of 20/20 despite healthy grafts and no ocular comorbidities. Reasons for this remain unclear, with theories including anterior stromal changes, differences in graft thickness and regularity, induced high-order aberrations, and the nature of the graft-host interface. Newer iterations of endothelial keratoplasty such as thin manual Descemet stripping endothelial keratoplasty, ultrathin automated Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty have achieved rates of 20/20 acuity of approximately 50%, comparable to modern cataract surgery, and it may be that a ceiling exists, particularly in the older age group of patients. Establishing the relative contribution of the factors that determine visual quality following endothelial keratoplasty will help drive further innovation, optimizing visual and patient-reported outcomes while improving surgical efficacy and safety.
Collapse
Affiliation(s)
- Andrew M J Turnbull
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK.
| | - Michael Tsatsos
- Moorfields Eye Hospital, London, UK; Modern Eye Centre, Thessaloniki, Greece
| | - Parwez N Hossain
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David F Anderson
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; University of Southampton, Southampton, UK
| |
Collapse
|
19
|
Donor cross-linking for keratoplasty: a laboratory evaluation. Graefes Arch Clin Exp Ophthalmol 2015; 253:2223-8. [PMID: 26345527 PMCID: PMC4653237 DOI: 10.1007/s00417-015-3160-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/03/2015] [Accepted: 08/21/2015] [Indexed: 12/28/2022] Open
Abstract
Purpose This laboratory-based investigation compares the topographic outcomes of conventional penetrating keratoplasty with that of a novel procedure in which donor corneas are cross-linked prior to keratoplasty. Methods Penetrating keratoplasty procedures with continuous running sutures were carried out in a porcine whole globe model. Sixty eyes were randomly paired as ‘donor’ and ‘host’ tissue before being assigned to one of two groups. In the cross-linked group, donor corneas underwent riboflavin/UVA cross-linking prior to being trephined and sutured to untreated hosts. In the conventional keratoplasty group, both host and donor corneas remained untreated prior to keratoplasty. Topographic and corneal wavefront measurements were performed following surgery, and technical aspects of the procedure evaluated. Results Mean keratometric astigmatism was significantly lower in the cross-linked donor group at 3.67D (SD 1.8 D), vs. 8.43 D (SD 2.4 D) in the conventional keratoplasty group (p < 0.005). Mean wavefront astigmatism was also significantly reduced in the cross-linked donor group 4.71 D (SD 2.1) vs. 8.29D (SD 3.6) in the conventional keratoplasty group (p < 0.005). Mean RMS higher order aberration was significantly lower in the cross-linked donor group at 1.79 um (SD 0.98), vs. 3.05 um (SD 1.9) in the conventional keratoplasty group (P = 0.02). Qualitative analysis revealed less tissue distortion at the graft-host junction in the cross-linked group. Conclusion Cross-linking of donor corneas prior to keratoplasty reduces intraoperative induced astigmatism and aberrations in an animal model. Further studies are indicated to evaluate the implications of this potential modification of keratoplasty surgery.
Collapse
|
20
|
Kamiya K, Asato H, Shimizu K, Kobashi H, Igarashi A. Effect of Intraocular Forward Scattering and Corneal Higher-Order Aberrations on Visual Acuity after Descemet's Stripping Automated Endothelial Keratoplasty. PLoS One 2015; 10:e0131110. [PMID: 26090889 PMCID: PMC4474429 DOI: 10.1371/journal.pone.0131110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/28/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the relationship of intraocular forward scattering and corneal higher-order aberrations (HOAs) with best spectacle corrected visual acuity (BSCVA) after Descemet’s stripping automated endothelial keratoplasty (DSAEK), and to compare these parameters between DSAEK and non-Descemet’s stripping automated endothelial keratoplasty (n-DSAEK) groups. Methods This retrospective study enrolled thirty eyes of 30 consecutive patients who underwent standard DSAEK, and who underwent successful phacoemulsification with intraocular lens implantation before DSAEK. The mean age at the time of surgery was 71.7 ± 10.4 years. We quantitatively evaluated the objective scattering index (OSI) using the double-pass instrument (OQAS II, Visiometrics) and corneal HOAs using Hartmann-Shack aberrometry (KR-9000PW, Topcon) 3 months postoperatively. Results The mean OSI, corneal HOAs, and logMAR BSCVA 3 months after DSAEK were 7.91 ± 3.58, 0.43 ± 0.27 μm, and 0.32 ± 0.25, respectively. We found a significant correlation between the OSI and logMAR BSCVA (Spearman correlation coefficient r=0.714, p<0.001), but no significant association between corneal HOAs and logMAR BSCVA 3 months postoperatively (r=0.209, p=0.267). We found no significant differences in any postoperative parameters between the DSAEK and n-DSAEK groups (p>0.05). Conclusions Our pilot study demonstrated that the postoperative corrected visual acuity was significantly correlated with intraocular forward scattering, but not with corneal HOAs in post-DSAEK eyes, suggesting that intraocular forward scattering plays a more essential role in postoperative visual performance than corneal aberrations after DSAEK. The detailed visual performance, such as HOAs and intraocular scattering, after n-DSAEK appears to be essentially equivalent to that after DSAEK.
Collapse
Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
- * E-mail:
| | - Hitomi Asato
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kimiya Shimizu
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Hidenaga Kobashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| |
Collapse
|
21
|
In vitro pilot analysis of uniformity, circularity, and concentricity of DSAEK donor endothelial grafts prepared by a microkeratome. Cornea 2014; 33:191-6. [PMID: 24326334 DOI: 10.1097/ico.0000000000000031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to analyze Descemet stripping automated endothelial keratoplasty donor endothelial grafts, prepared by using a microkeratome, in terms of uniformity, circularity, and concentricity. METHODS In this pilot study, 12 human donor corneas were prepared by means of a microkeratome and imaged using the Visante anterior segment optical coherence tomography along 4 meridians. The microkeratome enters and exits the corneal tissue at an angle, creating a donor graft bed with a uniform stromal (US) thickness in between the angled edges. We termed the angled portion the "nonuniform stromal transitional annulus" (STA), the point of entry and exit of the microkeratome the "epithelium-to-epithelium" (E-E) diameter, and the length of the US bed the "US" diameter. The E-E and US diameters were measured to create a model of each donor graft, from which circularity and concentricity were calculated. The STA length and height were measured, and the slope was calculated. RESULTS The mean E-E diameter was 10.69 ± 0.32 mm (range, 9.46-11.75 mm) and the mean US diameter was 8.96 ± 0.40 mm (range, 7.62-10.28 mm). The microkeratome generated elliptical rather than circular cuts, with a mean eccentricity of 0.34 ± 0.098 (range, 0.22-0.58). Eccentricity values between 0 and 1 represent ellipses, with zero characterizing a circle. The US ellipses and E-E ellipses were not concentric, with a mean deviation of the centers of the shapes of 177.06 ± 92.06 μm (range, 21.95-322.22 μm). The mean STA length was 0.73 ± 0.31 mm (range, 0.25-1.89 mm), the mean height was 0.43 ± 0.08 mm (range, 0.28-0.64 mm), and the mean slope was 34.11 ± 14.00° (range, 8.43-53.67°). CONCLUSIONS Microkeratome cuts created nonuniform, noncircular nonconcentric donor grafts. Asymmetry and nonuniformity of donor tissue may help explain suboptimal visual outcomes.
Collapse
|
22
|
van Dijk K, Droutsas K, Hou J, Sangsari S, Liarakos VS, Melles GRJ. Optical quality of the cornea after Descemet membrane endothelial keratoplasty. Am J Ophthalmol 2014; 158:71-79.e1. [PMID: 24784873 DOI: 10.1016/j.ajo.2014.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/09/2014] [Accepted: 04/14/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate corneal higher-order aberrations (HOAs) and backscattered light before and after Descemet membrane endothelial keratoplasty (DMEK) and their correlation with visual outcome. DESIGN Retrospective study. METHODS In a total of 118 consecutive eyes of 118 patients who underwent uneventful DMEK for Fuchs endothelial dystrophy at a tertiary referral center, best spectacle-corrected visual acuity (BSCVA), corneal HOAs, and backscattered light were evaluated preoperatively and at 6 months postoperatively. Outcome data were compared to an age-matched control group with uncomplicated eyes (n = 27). RESULTS Compared to the control group, Fuchs endothelial dystrophy eyes, before as well as 6 months after DMEK, showed higher values of anterior and posterior HOAs and backscattered light (P < .033). Postoperative anterior HOAs and backscattered light (0-2 mm) were associated with lower 6-month BSCVA (positively related with logMAR BSCVA) (P ≤ .020). Anterior corneal HOAs did not change from preoperative to 6 months after DMEK (P = .649), while total posterior HOAs (RMS third to sixth Zernike order) and haze decreased (P < .001). CONCLUSIONS Anterior and posterior corneal HOAs, as well as backscattered light from the cornea, were elevated in eyes suffering from Fuchs endothelial dystrophy and remained higher throughout 6 months after DMEK. If present, anterior surface irregularities and anterior corneal haze may be the most important limiting factors in visual rehabilitation after DMEK.
Collapse
Affiliation(s)
- Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands
| | - Konstantinos Droutsas
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands; Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
| | - Jingzhen Hou
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Amnitrans EyeBank, Rotterdam, Netherlands
| | - Sassan Sangsari
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Amnitrans EyeBank, Rotterdam, Netherlands
| | - Vasilios S Liarakos
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic, Rotterdam, Netherlands; Amnitrans EyeBank, Rotterdam, Netherlands.
| |
Collapse
|
23
|
Post-DSAEK optical changes: a comprehensive prospective analysis on the role of ocular wavefront aberrations, haze, and corneal thickness. Cornea 2014; 32:1567-77. [PMID: 24162748 DOI: 10.1097/ico.0b013e3182a9b182] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to assess the visual impact of ocular wavefront aberrations, corneal thickness, and corneal light scatter prospectively after performing a Descemet stripping automated endothelial keratoplasty (DSAEK) in humans. METHODS Data were obtained prospectively from 20 eyes preoperatively and at 1, 3, 6, and 12 months post-DSAEK. At each visit, the best spectacle-corrected visual acuity and visual acuity with glare (brightness acuity testing) were recorded, and ocular wavefront measurements and corneal optical coherence tomography (OCT) were performed. The magnitude and the sign of individual Zernike terms [higher-order aberrations (HOAs)] were determined. Epithelial, host stromal, donor stromal, and total corneal thicknesses were quantified. The brightness and intensity profiles of OCT images were generated to quantify light scatter in the whole cornea, subepithelial region, anterior and posterior host stroma, interface, and donor stroma. RESULTS The mean best spectacle-corrected visual acuity and glare disability at low light levels improved from 1 to 12 months post-DSAEK. All corneal thicknesses and ocular lower-order aberrations and HOAs were found to be stable from 1 to 12 months, whereas total corneal, host stromal, and interface brightness intensities decreased significantly over the same period. A repeated measures analysis of variance performed across the follow-up period revealed that the change in scatter, but not the change in the HOAs, could account for the variability occurring in the acuity from 1 to 12 months post-DSAEK. CONCLUSIONS Although ocular HOAs and scatter are both elevated over normal values post-DSAEK, our results demonstrate that the improvements in visual performance occurring over the first year post-DSAEK are associated with decreasing light scatter. In contrast, there were no significant changes in the ocular HOAs during this time. Because corneal light scatter decreased between 1 and 12 months despite there being stable corneal thicknesses over the same period, we conclude that factors that induced light scatter, other than tissue thickness or swelling (corneal edema), significantly impacted the visual improvements that occurred over time post-DSAEK. A better understanding of the cellular and extracellular matrix changes of the subepithelial region and interface, incurred by the surgical creation of a lamellar host-graft interface, and the subsequent healing of these tissues, is warranted.
Collapse
|
24
|
Weis AJ, Huxlin KR, Callan CL, DeMagistris MA, Hindman HB. Keratocyte apoptosis and not myofibroblast differentiation mark the graft/host interface at early time-points post-DSAEK in a cat model. PLoS One 2013; 8:e75623. [PMID: 24098706 PMCID: PMC3787047 DOI: 10.1371/journal.pone.0075623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/16/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate myofibroblast differentiation as an etiology of haze at the graft-host interface in a cat model of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK). METHODS DSAEK was performed on 10 eyes of 5 adult domestic short-hair cats. In vivo corneal imaging with slit lamp, confocal, and optical coherence tomography (OCT) were performed twice weekly. Cats were sacrificed and corneas harvested 4 hours, and 2, 4, 6, and 9 days post-DSAEK. Corneal sections were stained with the TUNEL method and immunohistochemistry was performed for α-smooth muscle actin (α-SMA) and fibronectin with DAPI counterstain. RESULTS At all in vivo imaging time-points, corneal OCT revealed an increase in backscatter of light and confocal imaging revealed an acellular zone at the graft-host interface. At all post-mortem time-points, immunohistochemistry revealed a complete absence of α-SMA staining at the graft-host interface. At 4 hours, extracellular fibronectin staining was identified along the graft-host interface and both fibronectin and TUNEL assay were positive within adjacent cells extending into the host stroma. By day 2, fibronectin and TUNEL staining diminished and a distinct acellular zone was present in the region of previously TUNEL-positive cells. CONCLUSIONS OCT imaging consistently showed increased reflectivity at the graft-host interface in cat corneas in the days post-DSAEK. This was not associated with myofibroblast differentiation at the graft-host interface, but rather with apoptosis and the development of a subsequent acellular zone. The roles of extracellular matrix changes and keratocyte cell death and repopulation should be investigated further as potential contributors to the interface optical changes.
Collapse
Affiliation(s)
- Adam J Weis
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | | | | | | | | |
Collapse
|
25
|
Acar BT, Utine CA, Acar S, Ciftci F. Reply: Laser in situ keratomileusis after deep anterior lamellar keratoplasty. J Cataract Refract Surg 2013; 39:482-3. [PMID: 23506938 DOI: 10.1016/j.jcrs.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Indexed: 10/27/2022]
|
26
|
Abstract
Corneal transplantation is among the most successful solid organ transplants. However, despite low rejection rates of grafts in the ‘low-risk’ setting, rejection can be as high as 70% when grafted into ‘high-risk’ recipient beds. Under normal homeostatic conditions, the avascular cornea provides a unique environment that facilitates immune and angiogenic privilege. An imbalance in pro-inflammatory, angiogenic and lymphangiogenic mediators leads to a breakdown in corneal immune privilege with a consequent host response against the donor graft. Recent developments in lamellar and endothelial keratoplasties have reduced the rates of graft rejection even more, while providing improved visual outcomes. The corneal layer against which an immune response is initiated, largely determines reversibility of the acute episode. While epithelial and stromal graft rejection may be treated with topical corticosteroids with higher success, acute endothelial rejection mandates a more aggressive approach to therapy due to the lack of regenerative capacity of this layer. However, current immunosuppressive regimens come with the caveat of ocular and systemic side effects, making prolonged aggressive treatment undesirable. With the advent of biologics, efficacious therapies with a superior side effect profile are on the horizon. In our review we discuss the mediators of ocular immune privilege, the roles of cellular and molecular immune players in graft rejection, with a focus on human leukocyte antigen and antigen presenting cells. Furthermore, we discuss the clinical risk factors for graft rejection and compare rates of rejection in lamellar and endothelial keratoplasties to traditional penetrating keratoplasty. Lastly, we present the current and upcoming measures of therapeutic strategies to manage and treat graft rejection, including an overview of biologics and small molecule therapy.
Collapse
Affiliation(s)
- Yureeda Qazi
- Ocular Surface and Imaging Center & Cornea Service Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Pedram Hamrah
- Ocular Surface and Imaging Center & Cornea Service Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|