Outcomes of keratoplasty in lattice corneal dystrophy in a large cohort of Indian eyes

Classic lattice corneal dystrophy: a brief review and summary of treatment modalities

PURPOSE

To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease.

METHODS

A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted.

RESULTS

LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment.

CONCLUSIONS

This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.

Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty

Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal and stromal corneal dystrophies: namely Reis–Bücklers, Thiel–Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. Due to the anterior location of the deposits in Reis-Bücklers and Thiel–Behnke dystrophies, PTK is considered the treatment of choice. For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.

Feasibility and Outcomes of Corneal Transplantation Performed at Rural Centers: An Extension of the Pyramidal Model of Enhanced Eye Care at Rural Outreach

PURPOSE

The aim of this study was to report on the feasibility of setting up a system of corneal transplants at rural outreach centers and report the outcomes of the first 111 cases.

METHODS

Retrospective analysis of the outcomes of corneal transplantation performed on patients with optical indications between March 2016 and September 2019 at 4 secondary (rural) centers. The centers are a part of a network in the pyramidal model developed by L V Prasad Eye Institute. The graft clarity and best-corrected visual acuity (BCVA) at 1-year follow-up were analyzed.

RESULTS

Of the 111 patients, 34.23% underwent penetrating keratoplasty and 65.77% endothelial keratoplasty. The mean age was 59.4 ± 15.0 (range-17-86 years); 47.75% were men and 52.25% were women. The indications for surgery were bullous keratopathy (54.05%), corneal scar/adherent leukoma (23.42%), and repeat grafts (13.51%). At the end of 1 year, 69.37% grafts remained clear. Factors associated with graft failure included poor socioeconomic status and graft infiltrate in both univariate and multivariate analyses. Surgical technique of endothelial keratoplasty was associated with failure on multivariate analysis only. Of the 77 eyes with clear corneal grafts at 1 year, the preoperative mean logMAR BCVA was 1.91 ± 0.06, which improved to 0.90 ± 0.08 postoperatively. Overall, 84.4% had preoperative BCVA of <3/60. Postoperatively, 40% had BCVA of 6/18 or better.

CONCLUSIONS

Our study showed that close to 70% grafts remained clear at 1 year. Graft failure was associated with poor socioeconomic status and graft infiltrates. This study established a viable model for delivery of corneal transplant surgery and care in a rural setup.

Outcomes of keratoplasty in a cohort of Indian patients with xeroderma pigmentosum

Purpose:

To evaluate the outcomes of keratoplasty for xeroderma pigmentosum (XP) performed at a tertiary eye care center.

Methods:

A retrospective review of medical records of those patients who were clinically diagnosed to have XP (54 eyes of 36 patients) and underwent keratoplasty; either deep anterior lamellar keratoplasty (DALK, four eyes), endothelial keratoplasty (EK, eight eyes), or penetrating keratoplasty (PK, 42 eyes) from 1994 to 2018.

Results:

The median age at surgery was 20.6 years (interquartile range [IQR], 14.6–27.6 years) and 20 (55.6%) were males. Graft failure occurred in 15 eyes (35.7%) in the PK group and two eyes (50%) in the DALK group; none failed in the EK group. The probability of graft survival in the PK group was 97.2% ± 2.7% at 1 year, 74.0% ± 8.0% at 2 years, and 54.8% ± 11.7% at 5 years. In the PK group, 13 eyes needed antiglaucoma medications, 11 eyes developed graft infiltrate, and 13 eyes needed secondary interventions (cataract surgery, excision biopsy, and tarsorrhaphy). In the EK group, three eyes needed secondary interventions (excision biopsy). Median postoperative endothelial cell density at the last follow-up in the PK group was 1214 cells/mm² (IQR, 623–2277 cells/mm²).

Conclusion:

Despite the complexities of the ocular surface and adnexal issues in XP, keratoplasty had reasonably good outcomes. More than half of the PK grafts survived 5 years with no failures in the EK group. Regular follow-up and timely management of suture-related infections raised intraocular pressure, and suspicious ocular surface lesions, in addition to solar protection, are important for the success of keratoplasty in these eyes.

Neurotrophic keratitis after penetrating keratoplasty for lattice dystrophy

Purpose

To report clinical outcomes of a patient with unilateral neurotrophic keratitis following penetrating keratoplasty for lattice dystrophy treated with topical recombinant human nerve growth factor.

Observations

A 75-year-old male with lattice dystrophy and history of herpes simplex keratitis, presented with recurrent neurotrophic ulceration in the right eye two years following penetrating keratoplasty. The patient was successfully treated with topical recombinant human nerve growth factor.

Conclusion

Neurotrophic keratitis is a rare chronic disorder that affects quality of life due to the risk of vision loss. Topical recombinant human nerve growth factor is a novel and effective treatment option that may help improve optical quality and patient's satisfaction as shown in this case of recurrent neurotrophic keratitis.

The morphogenesis of granular and lattice corneal dystrophy - A mutation combination hypothesis

Mutations in the BIGH3 gene encoding for keratoepithelin protein have been described in different corneal dystrophies viz. granular corneal dystrophy, lattice corneal dystrophy, and their different clinical subtypes. Even though linked to the BIGH3 gene, the role of BIGH3 gene in the pathogenesis of corneal lattice dystrophy and corneal granular dystrophy remains to be elucidated. We describe the probable functions of a mutated BIGH3 gene in disease pathogenesis, postulate the existence of other phenotype modifier mutations in these dystrophies, and how the coinheritance of these mutations in different combinations along with a normal/mutated BIGH3 gene can lead to the different morphologic patterns seen in these corneal dystrophies and their subtypes.

[Corneal dystrophies in optical coherence tomography]

BACKGROUND

Corneal optical coherence tomography (anterior segment OCT, AS-OCT) is described in the current IC3D classification of corneal dystrophies to be a method for improvement of clinical diagnostics and treatment.

OBJECTIVE

In this case series AS-OCT images of corneal dystrophies were analyzed with respect to morphological changes.

MATERIAL AND METHODS

This was a retrospective imaging and morphological case series with 38 eyes. For image acquisition the corneal module of the high-resolution spectral-domain OCT Zeiss Cirrus HD-5000 platform (Oberkochen, Germany) was employed. The following corneal dystrophies were analyzed: epithelial basement membrane dystrophy, Meesmann corneal dystrophy, Reis-Bücklers corneal dystrophy, granular corneal dystrophy type 1, granular corneal dystrophy type 2 and macular corneal dystrophy.

RESULTS

The AS-OCT images showed the typical changes of the dystrophies through hyperreflectivity and hyporeflectivity in the individual corneal layers. The findings in the AS-OCT images correlated well with the histological descriptions in the literature and provided additional information to the slit lamp examination, especially with respect to the exact location of the alterations.

CONCLUSION

Corneal AS-OCT imaging seems to be a helpful tool for determination of morphological changes in patients with corneal dystrophies and can facilitate both the diagnostics and surgical treatment decisions.