Long-term outcomes of hemi-automated lamellar keratoplasty

Intraoperative Optical Coherence Tomography (OCT)-Guided Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty (iFAD)

We describe retrospectively the indications and outcomes of nine patients who present with varying degrees of deep posterior stromal scarring or endothelial failure following deep anterior lamellar keratoplasty (DALK). These patients underwent a surgical strategy coined Intraoperative Optical Coherence Tomography Guided Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty (iFAD). This strategy can be used to address suboptimal visual outcomes following primary DALK. Patients undergoing iFAD first had femtosecond laser-assisted trephination of the underlying posterior lamella using the liquid keratoplasty system on the Femto LDV Z8 platform (Zeimer Ophthalmic Systems AG, Port, Switzerland). A Descemet Membrane Endothelial Keratoplasty (DMEK) graft was subsequently transplanted in place of the removed lamella. Out of nine cases, major indications for seven included post-infective, blepharokeratoconjunctivitis (BKC) and deep stromal scarring related to stromal dystrophy. The remaining two had endothelial failure following primary DALK. The main benefits of this surgical approach are (1) Utilization of integrated real-time iOCT on the femtosecond laser platform allows for precise calibration of a wide range of vertical posterior trephination depths (96-329 microns) from the endothelial surface. (2) Femtosecond laser trephination utilizing a non-applanation liquid interface preserves trephination geometries and maximises precision-based surgical outcomes. (3) iFAD is a viable and straightforward technique for surgeons addressing patients who might otherwise require complex surgery to address residual deep stromal scars post-DALK.

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.

Cytoprotective Effects of Human Platelet Lysate during the Xeno-Free Culture of Human Donor Corneas

We evaluated the suitability of 2% human platelet lysate medium (2%HPL) as a replacement for 2% fetal bovine serum medium (2%FBS) for the xeno-free organ culture of human donor corneas. A total of 32 corneas from 16 human donors were cultured in 2%FBS for 3 days (TP1), then evaluated using phase contrast microscopy (endothelial cell density (ECD) and cell morphology). Following an additional 25-day culture period (TP2) in either 2%FBS or 2%HPL, the pairs were again compared using microscopy; then stroma and Descemet membrane/endothelium (DmE) were processed for next generation sequencing (NGS). At TP2 the ECD was higher in the 2%HPL group (2179 ± 288 cells/mm²) compared to 2%FBS (2113 ± 331 cells/mm²; p = 0.03), and endothelial cell loss was lower (ECL HPL = -0.7% vs. FBS = -3.8%; p = 0.01). There were no significant differences in cell morphology between TP1 and 2, or between 2%HPL and 2%FBS. NGS showed the differential expression of 1644 genes in endothelial cells and 217 genes in stromal cells. It was found that 2%HPL led to the upregulation of cytoprotective, anti-inflammatory and anti-fibrotic genes (HMOX1, SERPINE1, ANGPTL4, LEFTY2, GADD45B, PLIN2, PTX3, GFRA1/2), and the downregulation of pro-inflammatory/apoptotic genes (e.g., CXCL14, SIK1B, PLK5, PPP2R3B, FABP5, MAL, GATA3). 2%HPL is a suitable xeno-free substitution for 2%FBS in human cornea organ culture, inducing less ECL and producing potentially beneficial alterations in gene expression.

Ex vivo sensing and imaging of corneal scar tissues using terahertz time domain spectroscopy

Pulsed terahertz (THz) broadband spectroscopy and imaging were applied to investigate ex vivo rabbit corneal scar tissues. Scars with different depths and densities were created by laser ablation on four corneal samples while two corneal samples untouched were used as control. The THz time-domain spectroscopy and reconstructed images illustrated the scar tissue density and gave out depth variation distribution profiles. Calculated absorption coefficient spectra displayed extra absorption peaks compared with control corneas and refractive index spectra showed the optical properties changed at the corneal scar locations. THz spectroscopy and imaging demonstrated adequate contrast in reviewing the scar densities and locations and showed potential applications in depicting spatial distribution and composition changes of corneal scars.