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Rafati-Rahimzadeh M, Rafati-Rahimzadeh M, Kazemi S, Jafarian Amiri SR, Soleymani A, Moghadamnia AA. Ophthalmological aspects of mustard gas poisoning (focus on management). CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:458-468. [PMID: 35974928 PMCID: PMC9348212 DOI: 10.22088/cjim.13.3.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 10/31/2022]
Abstract
Background Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as "King of chemical warfare (CW) agents ". Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management. Methods A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported. Results Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes. Conclusion Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.
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Affiliation(s)
- Mehrdad Rafati-Rahimzadeh
- Department of Nursing, Babol University of Medical Sciences, Babol, Iran,Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Sohrab Kazemi
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Abbas Soleymani
- Department of Ophthalmology, Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Moghadamnia
- Department of Ophthalmology, Babol University of Medical Sciences, Babol, Iran ,Correspondence: Ali Akbar Moghadamnia , Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. E-mail: , Tel: 0098 1132207918, Fax: 0098 1132207918
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Shams M, Sharifi A, Akbari Z, Maghsoudlou A, Reza Tajali M. Penetrating Keratoplasty versus Deep Anterior Lamellar Keratoplasty for Keratoconus: A Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2022; 17:89-107. [PMID: 35194500 PMCID: PMC8850853 DOI: 10.18502/jovr.v17i1.10174] [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: 03/05/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Keratoconus is the most common form of primary corneal thinning. Different methods have been suggested to deal with the condition, including glasses, contact lenses, and surgical interventions, like penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK), well-known methods of the latter. This study was conducted to compare the outcomes and side effects of the two mentioned keratoplasty techniques. First, we systematically reviewed all original articles studies on PubMed, Scopus, Web of Science, and Embase. Then, the extracted data were pooled and meta-analyzed on each of the intended outcomes. A total of 30 studies were included in which PKP was more commonly performed compared to DALK. We found that adverse outcomes consisting of cataracts, graft rejection, graft failure, High-IOP, and corneal infection, were all more common findings in the PKP groups compared to the DALK groups. However, only for the high-IOP, cataracts, and graft rejection, the analysis of the extracted results demonstrated statistical significance. Overall, the DALK groups demonstrated significantly better results when considering the improvement levels by measuring the Endothelial Cell Count (ECC) and Spherical Equivalent (SE). In addition, though statistically insignificant, the Central Corneal Thickness(CCT), Best Corrected Visual Acuity(BCVA), Topographic Cylinder(TC), Refractive Cylinder values were greater in the PKP groups. Based on our study and with its limitations in mind, we can conclude that DALK can be a relatively safer and more effective procedure. Though, a larger number of high-standard randomized clinical trials still need to be conveyed for more definite conclusions.
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Affiliation(s)
- Majid Shams
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Akbari
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Sheludchenko VM, Voronin GV, Osipyan GA, Djalili RA. [Methods of surgical treatment of keratectasia and analysis of postsurgical quality of vision]. Vestn Oftalmol 2020; 136:308-316. [PMID: 33063982 DOI: 10.17116/oftalma2020136052308] [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] [Indexed: 11/17/2022]
Abstract
Keratectasias are non-inflammatory dystrophic diseases of the cornea characterized by progressive bilateral thinning of the cornea that lead to deterioration in the quantitative and qualitative characteristics of vision reducing patient's quality of life. The changes can be asymmetrical and destructive. A number of surgeries have been proposed to reduce the negative effects of keratectasia including penetrating keratoplasty and its modifications, implantation of corneal ring segments, corneal cross-linking - alone and in combination with other methods, intrastromal keratoplasty. These methods can improve visual acuity to a certain degree and help slow the progression of keratectasia. This article studies various surgical methods used for treating keratectasia and analyses possible assessment of the quality of vision before and after the treatment.
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Affiliation(s)
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Djalili
- Research Institute of Eye Diseases, Moscow, Russia
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Mohammadpour M, Heidari Z, Hashemi H. Updates on Managements for Keratoconus. J Curr Ophthalmol 2017; 30:110-124. [PMID: 29988906 PMCID: PMC6034171 DOI: 10.1016/j.joco.2017.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/07/2017] [Accepted: 11/05/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose Keratoconus is a progressive disease of the cornea which can lead to blindness as irregular astigmatism increases. Currently, a variety of methods are available for the treatment of keratoconus, and in certain cases, it may be difficult to choose the most appropriate option. This article reviews available treatment modalities for keratoconus to provide the practitioner with practical and useful information for selecting the most suitable option for each individual patient. Methods To review treatment methods for different stages of keratoconus, PubMed (United States National Library of Medicine) and Scopus (Elsevier BV) databases were searched using the keywords “keratoconus”, “contact lens”, “cross-linking”, “Intacs”, “keratoplasty”, “gene therapy”, and “irregular astigmatism”, and related articles were reviewed based on disease assessment parameters and treatment methods. Results Various methods are available for the treatment of keratoconus: eyeglasses and contact lenses in the early stages, cross-linking for stabilizing disease progression, intrastromal corneal ring segments (ICRS) for reducing refractive errors or flattening the cornea, and penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), conductive keratoplasty, gene therapy and more recently, bowman layer transplantation (BL transplantation) in advanced stages of the disease. To achieve optimum results, it is essential to choose the best option for each individual patient. Conclusions A commonality of the reviewed papers was the advancement of novel diagnostic and treatment methods in ophthalmology, which can delay the need for corneal grafting. A better understanding of keratoconus treatment options can help enhance visual rehabilitation and prevent blindness in keratoconus patients.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Zahra Heidari
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Corresponding author. No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Yüksel B, Kandemir B, Uzunel UD, Çelik O, Ceylan S, Küsbeci T. Comparison of visual and topographic outcomes of deep-anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus. Int J Ophthalmol 2017; 10:385-390. [PMID: 28393029 DOI: 10.18240/ijo.2017.03.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/03/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare visual, surgical and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus (KC). METHODS In this multicenter, prospective, randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK. RESULTS Mean best spectacle corrected visual acuity (BSCVA) at the first postoperative week (P=0.012) and the first postoperative month (P<0.001) was statistically significantly higher in DALK group. The mean BSCVA at 12mo was not significantly different for DALK (0.30±1.99 logMAR) versus PK (0.40±0.33 logMAR) (P=0.104). The 76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4% in PK group (P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group (P=0.644). Mean spherical equivalent was -2.94 D in DALK and -3.09 D in PK group. Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31 (81.6%) of DALK and 29 (76.3%) of PK (P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie, seen in 39.5% in DALK and 23.7% in PK. CONCLUSION Big bubble DALK provides an earlier visual improvement compare to PK. However, visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However, intraoperative perforation of the Descemet's membrane is a significant complication.
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Affiliation(s)
- Bora Yüksel
- Department of Ophthalmology, Izmir Bozyaka Training and Research Hospital, Izmir 35110, Turkey
| | - Baran Kandemir
- Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul 34660, Turkey
| | - Umut Duygu Uzunel
- Department of Ophthalmology, Izmir Bozyaka Training and Research Hospital, Izmir 35110, Turkey
| | - Ozan Çelik
- Department of Ophthalmology, Izmir Bozyaka Training and Research Hospital, Izmir 35110, Turkey
| | - Sezgin Ceylan
- Department of Ophthalmology, Kartal Training and Research Hospital, Istanbul 34660, Turkey
| | - Tuncay Küsbeci
- Department of Ophthalmology, Izmir Bozyaka Training and Research Hospital, Izmir 35110, Turkey
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Mai ELC, Lian IB, Chang DCK. Assessment of contrast sensitivity loss after intrastromal femtosecond laser and LASIK procedure. Int J Ophthalmol 2016; 9:1798-1801. [PMID: 28003982 DOI: 10.18240/ijo.2016.12.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the loss of contrast sensitivity (CS) function for INTRACOR or intrastromal femtosecond laser presbyopia procedure to conventional LASIK procedures. METHODS Patients were recruited from a refractive surgery center for either INTRACOR or conventional LASIK. INTRACOR was performed on 8 eyes and LASIK was performed for 40 eyes in an overlapping period. Pre-operative evaluation and post-operative follow up for up to three months was done. Drops of CS in 4 spatial frequency (3 cpd, 6 cpd, 12 cpd and 18 cpd) right before and 3mo after the surgery were compared by Wilcoxon signed ranks test. RESULTS For INTRACOR, CS threshold showed significant drop at both glare and non-glare condition, the drop was seen in all 4 spatial frequency. The averaged loss over the 4 spatial frequencies 3mo after surgery was 1.18 for non-glare and 0.71 for glare. For LASIK the CS threshold drop was most significant in 12 cpd for glare. CONCLUSION INTRACOR procedure produces a gain of near vision for presbyopia patients but also introduces a high lost of contrast sensitivity plus worsen of vision quality. Pre-surgical patient selection and advise should be given with specific regards to night driving and glare conditions.
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Affiliation(s)
- Elsa L C Mai
- Far Eastern Memorial Hospital, Taipei 100, Taiwan, China
| | - Ie-Bin Lian
- National Changhua University of Education, Changhua 500, Taiwan, China
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Zhang J, Zhang CW, Du LQ, Wu XY. Acellular porcine corneal matrix as a carrier scaffold for cultivating human corneal epithelial cells and fibroblasts in vitro. Int J Ophthalmol 2016; 9:1-8. [PMID: 26949602 DOI: 10.18240/ijo.2016.01.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022] Open
Abstract
AIM To investigate the feasibility of corneal anterior lamellar reconstruction with human corneal epithelial cells and fibroblasts, and an acellular porcine cornea matrix (APCM) in vitro. METHODS The scaffold was prepared from fresh porcine corneas which were treated with 0.5% sodium dodecyl sulfate (SDS) solution and the complete removal of corneal cells was confirmed by hematoxylin-eosin (HE) staining and 4', 6-diamidino-2-phenylindole (DAPI) staining. Human corneal fibroblasts and epithelial cells were cultured with leaching liquid extracted from APCM, and then cell proliferative ability was evaluated by MTT assay. To construct a human corneal anterior lamellar replacement, corneal fibroblasts were injected into the APCM and cultured for 3d, followed by culturing corneal epithelial cells on the stroma construction surface for another 10d. The corneal replacement was analyzed by HE staining, and immunofluorescence staining. RESULTS Histological examination indicated that there were no cells in the APCM by HE staining, and DAPI staining did not detect any residual DNA. The leaching liquid from APCM had little influence on the proliferation ability of human corneal fibroblasts and epithelial cells. At 10d, a continuous 3 to 5 layers of human corneal epithelial cells covering the surface of the APCM was observed, and the injected corneal fibroblasts distributed within the scaffold. The phenotype of the construction was similar to normal human corneas, with high expression of cytokeratin 12 in the epithelial cell layer and high expression of vimentin in the stroma. CONCLUSION Corneal anterior lamellar replacement can be reconstructed in vitro by cultivating human corneal epithelial cells and fibroblasts with an acellular porcine cornea matrix. This laid the foundation for the further transplantation in vivo.
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Affiliation(s)
- Ju Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Can-Wei Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Li-Qun Du
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xin-Yi Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis. PLoS One 2015; 10:e0113332. [PMID: 25633311 PMCID: PMC4310590 DOI: 10.1371/journal.pone.0113332] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 10/27/2014] [Indexed: 01/11/2023] Open
Abstract
Purpose To evaluate difference in therapeutic outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for the clinical treatment of keratoconus. Methods A comprehensive search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of science. Eligible studies should include at least one of the following factors: best corrected visual acuity (BCVA), postoperative spherical equivalent (SE), postoperative astigmatism and endothelial cell count (ECC), central corneal thickness (CCT), graft rejection and graft failure, of which BCVA, graft rejection and graft failure were used as the primary outcome measures, and postoperative SE, astigmatism, CCT and ECC as the secondary outcome measures. Given the lack of randomized clinical trials (RCTs), cohort studies and prospective studies were considered eligible. Results Sixteen clinical trials involving 6625 eyes were included in this review, including 1185 eyes in DALK group, and 5440 eyes in PKP group. The outcomes were analyzed using Cochrane Review Manager (RevMan) version 5.0 software. The postoperative BCVA in DALK group was significantly better than that in PKP group (OR = 0.48; 95%CI 0.39 to 0.60; p<0.001). There were fewer cases of graft rejection in DALK group than those in PKP group (OR = 0.28; 95%CI 0.15 to 0.50; p<0.001). Nevertheless the rate of graft failure was similar between DALK and PKP groups (OR = 1.05; 95%CI 0.81 to 1.36; p = 0.73). There were no significant differences in the secondary outcomes of SE (p = 0.70), astigmatism (p = 0.14) and CCT (p = 0.58) between DALK and PKP groups. And ECC in DALK group was significantly higher than PKP group (p<0.001). The postoperative complications, high intraocular pressure (high-IOP) and cataract were analyzed, fewer cases of complications occurred in DALK group than those in PKP group (high-IOP, OR 0.22, 95% CI 0.11–0.44, P<0.001) (cataract, OR 0.22; 95% CI 0.08–0.61, P = 0.004). And no cases of expulsive hemorrhage and endophthalmitis were reported. Conclusion The visual outcomes for DALK were not equivalent to PKP. The rate of graft failure was similar between DALK and PKP. Fewer postoperative complications occurred in DALK group, indicating that compared with PKP, DALK has lower efficacy but higher safety.
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Acar BT, Akdemir MO, Acar S. Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results. Int J Ophthalmol 2014; 7:974-9. [PMID: 25540749 DOI: 10.3980/j.issn.2222-3959.2014.06.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/10/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet's stripping automated endothelial keratoplasty (DSAEK) one year after surgery. METHODS DSAEK patients' data were reviewed. Thirty-seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy (PBK) were included in this study. Graft thickness was measured with optical coherence tomography (OCT) 12mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness: thick (>200 µm), medium-thick (150-200 µm) and thin (<150 µm). Best corrected visual acuity (BCVA), endothelial cells density (ECD) and complications were assessed and comparisons were done between groups. RESULTS There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12mo, mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts (P=0.001). Thick graft group had 1637.44±88.19-mm(2), medium thick graft had 1764.50±34.28-mm(2) and thin graft group had 1845.30±65.62-mm(2) ECD at 12mo after the surgery. Thin graft group had better ECD at 12mo after surgery (P=0.001). CONCLUSION Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes with medium-thick and thick grafts one year after surgery.
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Affiliation(s)
- Banu Torun Acar
- Ophthalmology Clinic, Haydarpasa Numune Research and Education Hospital, Istanbul 34668, Turkey
| | - Mehmet Orcun Akdemir
- Department of Ophthalmology, School of Medicine, Bulent Ecevit University, Zonguldak 67600, Turkey
| | - Suphi Acar
- Ophthalmology Clinic, Haydarpasa Numune Research and Education Hospital, Istanbul 34668, Turkey
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Lamellar keratoplasty: a literature review. J Ophthalmol 2013; 2013:894319. [PMID: 24223301 PMCID: PMC3816057 DOI: 10.1155/2013/894319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/01/2013] [Accepted: 08/19/2013] [Indexed: 12/02/2022] Open
Abstract
The concept of lamellar keratoplasty (LK) is not new. However, newer forms of lamellar keratoplasty techniques have emerged in the last decade or so revolving around the concept of targeted replacement of diseased corneal layers. These include anterior lamellar keratoplasty (ALK) techniques that aim to selectively replace diseased corneal stroma and endothelial keratoplasty techniques aiming to replaced damaged endothelium in endothelial disorders. Recent improvements in surgical instruments and introduction of new techniques as well as inherent advantages such as preservation of globe integrity and decreased graft rejection have resulted in the reintroduction of LK as an acceptable alternative to conventional PK. In this review, indications, benefits, limitations, and outcomes of various anterior and posterior lamellar keratoplasty techniques are discussed.
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