1
|
Flockerzi E, Turner C, Seitz B, Collaborators GSG. Descemet's membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol 2024; 108:646-653. [PMID: 37586835 PMCID: PMC11137454 DOI: 10.1136/bjo-2022-323162] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND/AIMS This retrospective multicentric panel study provides absolute numbers, types of and indications for corneal transplantation in Germany from 2011 to 2021 and sets them into the international context. METHODS A questionnaire was sent to the 104 German ophthalmologic surgery departments and 93 (89%) provided their data. RESULTS The number of reported keratoplasties more than doubled from 2011 (n=4474) to 2021 (n=8998). Lamellar keratoplasties (49% posterior (n=2883), 4% anterior (n=231)) surpassed penetrating keratoplasty (PKP, 47%, n=2721) for the first time in 2014. Since 2016, Descemet's membrane endothelial keratoplasty (DMEK) has become the predominant keratoplasty procedure in Germany. Its number increased by 1.5-fold from 3850 (2016) to 5812 (2021). Main indications in 2021 were Fuchs' endothelial corneal dystrophy (FECD, 43%), pseudophakic corneal decompensation (12%), repeated keratoplasty (11%), infections (7%), keratoconus (6%) and corneal scarring (4%, others: 9%). The PKP percentage decreased from 70.2% in 2011 (n=3141) to 31.7% in 2021 (n=2853). Descemet's stripping (automated) endothelial keratoplasties (DSAEKs) decreased to 1% in 2021 (n=74). 98.6% of all posterior lamellar keratoplasties were DMEKs in Germany in 2021. The number of deep anterior lamellar keratoplasties (DALKs) remained comparable from 2011 (n=269) to 2021 (n=251, 2.8%). CONCLUSION Main indications for corneal transplantation in Germany (2021) were FECD and pseudophakic corneal decompensation. DMEK is by far the predominant corneal transplantation procedure since 2016 followed by PKP, whose absolute number decreased only slightly during the decade from 2011 to 2021. DALK proportions remain low, but stable, whereas DSAEK decreased annually and plays a minor role in Germany. TRIAL REGISTRATION NUMBER NCT03381794.
Collapse
Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Turner
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - GeKeR Study Group Collaborators
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| |
Collapse
|
2
|
van der Star L, Vasiliauskaitė I, Oellerich S, Groeneveld-van Beek EA, Ghaly M, Laouani A, Vasanthananthan K, van Dijk K, Dapena I, Melles GRJ, Kocaba V. Bowman Layer Onlay Grafting as a Minimally Invasive Treatment for the Most Challenging Cases in Keratoconus. Am J Ophthalmol 2024; 261:54-65. [PMID: 37935272 DOI: 10.1016/j.ajo.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. DESIGN Prospective, interventional case series. METHODS Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was "stretched" onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months). RESULTS All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. CONCLUSIONS BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to -6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.
Collapse
Affiliation(s)
- Lydia van der Star
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Indrė Vasiliauskaitė
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Silke Oellerich
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Esther A Groeneveld-van Beek
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Mohamed Ghaly
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Achraf Laouani
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Keamela Vasanthananthan
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Korine van Dijk
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Isabel Dapena
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam
| | - Gerrit R J Melles
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Amnitrans EyeBank Rotterdam (G.R.J.M., V.K.), Rotterdam, The Netherlands.
| | - Viridiana Kocaba
- From the Netherlands Institute for Innovative Ocular Surgery (L.v.d.S., I.V., S.O., E.A.G., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Melles Cornea Clinic (L.v.d.S., I.V., M.G., A.L., K.V., K.v.D., I.D., G.R.J.M., V.K.), Rotterdam; Amnitrans EyeBank Rotterdam (G.R.J.M., V.K.), Rotterdam, The Netherlands
| |
Collapse
|
4
|
Niazi S, del Barrio JA, Doroodgar F, Javadi MA, Alió JL. Main issues in deep anterior lamellar keratoplasty: A systematic narrative review. Taiwan J Ophthalmol 2024; 14:34-43. [PMID: 38654987 PMCID: PMC11034680 DOI: 10.4103/tjo.tjo-d-23-00175] [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: 11/09/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
Collapse
Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge Alió del Barrio
- Department of Cornea, Cataract and Refractive Surgery, Vissum Corporación, Alicante, Spain
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L. Alió
- Division of Ophthalmology, Miguel Hernández University of Elche, Alicante, Spain
- Vissum Miranza, Alicante, Spain
| |
Collapse
|
5
|
Alió JL, Niazi S, Doroodgar F, Barrio JLAD, Hashemi H, Javadi MA. Main issues in penetrating keratoplasty. Taiwan J Ophthalmol 2024; 14:50-58. [PMID: 38654981 PMCID: PMC11034681 DOI: 10.4103/tjo.tjo-d-24-00001] [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: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 04/26/2024] Open
Abstract
This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers' impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care's significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.
Collapse
Affiliation(s)
- Jorge L. Alió
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Vissum Miranza Alicante, Alicante, Spain
| | - Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Dou S, Liu X, Shi W, Gao H. New dawn for keratoconus treatment: potential strategies for corneal stromal regeneration. Stem Cell Res Ther 2023; 14:317. [PMID: 37932824 PMCID: PMC10629149 DOI: 10.1186/s13287-023-03548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
Keratoconus is a progressive, ectatic and blinding disorder of the cornea, characterized by thinning of corneal stroma. As a highly prevalent among adolescents, keratoconus has been a leading indication for corneal transplantation worldwide. However, the severe shortage of donor corneas is a global issue, and the traditional corneal transplantation surgeries may superinduce multiple complications, necessitating efforts to develop more effective strategies for keratoconus treatment. In this review, we summarized several strategies to promote corneal stromal regeneration or improve corneal stromal thickness, including cell-based therapies, biosynthetic alternatives for inducing corneal regeneration, minimally invasive intrastromal implantation and bioengineered tissues for implantation. These strategies provided more accessible but safer alternatives from various perspectives for keratoconus treatment, paving the way for arresting the keratoconus progression in its earlier stage. For the treatments of corneal ectatic diseases beyond keratoconus, these approaches will provide important references and widen the therapy options in a donor tissue-independent manner.
Collapse
Affiliation(s)
- Shengqian Dou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Xiaoxue Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Eye Hospital of Shandong First Medical University, Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Weiyun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Eye Hospital of Shandong First Medical University, Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China.
- Eye Hospital of Shandong First Medical University, Jinan, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, China.
| |
Collapse
|
8
|
Yüksel B, Küsbeci T, Gümüş F, Kocakaya AE. Long-Term Endothelial Cell Viability After Deep Anterior Lamellar Versus Penetrating Keratoplasty for Keratoconus. EXP CLIN TRANSPLANT 2023; 21:599-606. [PMID: 37584541 DOI: 10.6002/ect.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVES We compared long-term endothelial cell survival after penetrating versus after deep anterior lamellar keratoplasty for keratoconus. MATERIALS AND METHODS We retrospectively compared 64 eyes of 55 patients who had penetrating keratoplasty and 40 eyes of 37 patients who had deep anterior lamellar keratoplasty for keratoconus (October 2003-February 2021). Best-corrected visual acuity, Goldmann applanation tonometry, fundus examination with 90D lens, and specular microscopy with CEM-530 (Nidek) were performed preoperatively and every 6 months postoperatively. Main outcomes were endothelial cell density, central corneal thickness, and visual acuity. Secondary outcomes were coefficient of variation, hexagonality, graft rejection episodes, and graft clarity. RESULTS We found no significant differences between the 2 treatment groups regarding patient age, donor age, preoperative vision, central corneal thickness, and recipient-donor trephine diameters. Mean follow-up was 92.5 months. In deep anterior lamellar keratoplasty, the endothelium was preserved significantly better for 10 years versus for penetrating keratoplasty. Mean endothelial density in penetrating versus deep anterior lamellar keratoplasty was 2006.7 versus 2354.7 cells/mm2 at 1 year (P = .010), 1170.5 versus 2048.2 at 5 years (P <.001), and 972.5 versus 1831.6 at 10 years (P < .001). Cumulative endothelial cell loss was 43% and 19.7% at 10 years for penetrating and anterior lamellar keratoplasty, respectively. Significantly more thickening of central cornea was shown in penetrating keratoplasty after 7 years. Corneal thickness was 583.0 µm in penetrating and 545.1 µm in deep anterior lamellar keratoplasty (P = .002) at 10 years. Vision gain and coefficient of variation were similar. Hexagonality decreased significantly in both groups at 10 years. Rates of rejection were 12.5% in penetrating and 7.5% in deep anterior lamellar keratoplasty. Graft survival rates were 97.5% and 96.9%, respectively. CONCLUSIONS In keratoconus, endothelial vitality is better preserved with deep anterior lamellar keratoplasty than with penetrating keratoplasty over a 10-year follow-up.
Collapse
Affiliation(s)
- Bora Yüksel
- From the Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | | | | | | |
Collapse
|
9
|
Greenstein SA, Yu AS, Gelles JD, Eshraghi H, Hersh PS. Corneal tissue addition keratoplasty: new intrastromal inlay procedure for keratoconus using femtosecond laser-shaped preserved corneal tissue. J Cataract Refract Surg 2023; 49:740-746. [PMID: 36943309 DOI: 10.1097/j.jcrs.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To report results of Corneal Tissue Addition Keratoplasty (CTAK) for keratoconus (KC) and ectasia after laser in situ keratomileusis. SETTING Cornea and refractive surgery practice. DESIGN Single center, prospective, open label clinical trial. METHODS 21 eyes of 18 patients underwent CTAK. A tissue inlay of preserved corneal tissue was cut to customized specifications with a femtosecond laser and placed in a laser-created channel in the host cornea. Postoperative uncorrected and corrected distance visual acuity (UDVA, CDVA), manifest refraction spherical equivalent (MRSE), topographic mean keratometry (Kmean), maximum keratometry (Kmax), and the point of maximum flattening (Kmaxflat) were measured. RESULTS Average UDVA improved from 1.21 ± 0.35 logMAR lines (LL) (20/327) to 0.61 ± 0.25 LL (20/82) ( P < .001). Average CDVA improved from 0.62 ± 0.33 LL (20/82) to 0.34 ± 0.21 LL (20/43) ( P = .002), and average MRSE improved from -6.25 ± 5.45 diopters (D) to -1.61 ± 3.33 D ( P = .002). Individually, 20 eyes (95.2%) gained more than 2 lines of UDVA, with 10 eyes (47.6%) gaining more than 6 lines, and no eyes worsening. 12 eyes (57.1%) gained at least 2 lines of CDVA, with 1 eye worsening by more than 2 lines. At 6 months, average Kmean flattened by -8.44 D ( P = .002), Kmax flattened by -6.91 D ( P = .096), and mean Kmaxflat was -16.03 D. CONCLUSIONS CTAK is a promising procedure to improve visual acuity and topography in patients with KC and ectasia.
Collapse
Affiliation(s)
- Steven A Greenstein
- From the Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, New Jersey (Greenstein, Yu, Gelles, Hersh); Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey (Greenstein, Gelles, Eshraghi, Hersh)
| | | | | | | | | |
Collapse
|