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Mosca L, Scartozzi L, De Filippis A, Guccione L, Fasciani R, Rizzo S. 3D Heads-up digital filters for cataract surgery and corneal transplantation. Eur J Ophthalmol 2024:11206721241253633. [PMID: 38710197 DOI: 10.1177/11206721241253633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE To describe the advantages of Ngenuity 3D digital filters for enhancing visualization during cataract and corneal transplant surgery. METHODS All surgeries were performed by the same experienced surgeon (L.M.) using the Ngenuity 3D heads-up visualization system connected to a microscope. Images were simultaneously captured with and without the filter in each of the following phases: endothelial evaluation, capsulorhexis, capsule rupture, vitreous leak, cortex removal, visco removal, corneal suture, descemetorhexis, DMEK graft preparation and insertion. RESULTS In cataract surgery, green and monochrome filters facilitate capsulorhexis in difficult situations by highlighting the anterior capsule and can improve visualization of a posterior capsular tear. The enhanced contrast of the monochrome filter is also useful for cortex and viscoelastic removal. In corneal surgery, the green filter highlights the rim of the DMEK graft during tissue preparation, the yellow filter enhances the contrast of the stained DMEK graft in the anterior chamber, the monochrome filter simplifies descemetorhexis by improving visualization of the Descemet/endothelial layer and allows a better view in red saturated images while performing sutures. CONCLUSIONS Ngenuity digital filters have the potential to enhance tissue visualization during cataract and corneal surgeries, especially in poor visibility conditions.
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Affiliation(s)
- Luigi Mosca
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Cornea and Refractive Surgery Unit, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
| | - Luca Scartozzi
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
| | - Alessandro De Filippis
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
| | - Laura Guccione
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Cornea and Refractive Surgery Unit, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
| | - Romina Fasciani
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Cornea and Refractive Surgery Unit, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
| | - Stanislao Rizzo
- Catholic University of Sacred Heart - Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
- Department of Ophthalmology, Agostino Gemelli Polyclinic Foundation - IRCSS, Rome, Italy
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Przybek-Skrzypecka J, Samelska K, Ordon AJ, Skrzypecki J, Izdebska J, Kołątaj M, Szaflik JP. Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants-A Comprehensive Review. J Clin Med 2024; 13:2326. [PMID: 38673599 PMCID: PMC11051457 DOI: 10.3390/jcm13082326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.
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Affiliation(s)
- Joanna Przybek-Skrzypecka
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Katarzyna Samelska
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Agata Joanna Ordon
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
- Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, 90-647 Lodz, Poland
| | - Janusz Skrzypecki
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, 00-576 Warsaw, Poland;
| | - Justyna Izdebska
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Marta Kołątaj
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
| | - Jacek P. Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576 Warsaw, Poland; (K.S.); (J.I.); (J.P.S.)
- SPKSO Ophthalmic University Hospital in Warsaw, 00-576 Warsaw, Poland; (A.J.O.); (M.K.)
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Toyokawa N, Araki-Sasaki K, Kimura H, Kuroda S. Changes in the Visual Field Test after Descemet Stripping Automated Endothelial Keratoplasty in Advanced Glaucoma. J Clin Med 2024; 13:1431. [PMID: 38592688 PMCID: PMC10934157 DOI: 10.3390/jcm13051431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from -22.24 ± 6.5 dB to -18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes.
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Affiliation(s)
- Noriko Toyokawa
- Nagata Eye Clinic, 1147 Kitayamada Horai, Nara City 631-0844, Nara, Japan; (N.T.); (H.K.); (S.K.)
| | - Kaoru Araki-Sasaki
- Nagata Eye Clinic, 1147 Kitayamada Horai, Nara City 631-0844, Nara, Japan; (N.T.); (H.K.); (S.K.)
- Department of Ophthalmology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City 573-1010, Osaka, Japan
| | - Hideya Kimura
- Nagata Eye Clinic, 1147 Kitayamada Horai, Nara City 631-0844, Nara, Japan; (N.T.); (H.K.); (S.K.)
| | - Shinichiro Kuroda
- Nagata Eye Clinic, 1147 Kitayamada Horai, Nara City 631-0844, Nara, Japan; (N.T.); (H.K.); (S.K.)
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Westin IM, Viberg A, Golovleva I, Byström B. CTG18.1 expansion in transcription factor 4 (TCF4) in corneal graft failure: preliminary study. Cell Tissue Bank 2024:10.1007/s10561-023-10123-y. [PMID: 38206443 DOI: 10.1007/s10561-023-10123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is caused by a corneal endothelial cell loss, leading to corneal edema and visual impairment. The most significant genetic risk factor for FECD is an expansion of the CTG18.1 locus in transcription factor 4 (TCF4). The current treatment for severe FECD is corneal transplantation, with Descemet stripping automated keratoplasty (DSAEK) as a common surgical method. Although successful in most cases, the risk for transplant failure due to diverse causes must be considered. In this study, we investigated if presence of TCF4 CTG18.1 expansion with more than 31 (n ≥ 31) repeats in donated corneal grafts could be a reason for corneal transplant failure after DSAEK. For this, nine consecutively failed DSAEK corneal grafts were genotyped for CTG18.1 repeat length. One-sided Mann-Whitney U test was performed to evaluate if failed DSAEK corneal grafts had longer CTG18.1 repeats than healthy controls from the same population. All failed corneal grafts had CTG18.1 n ≤ 27 with a median of 18 (IQR 8.0) repeats for the longest allele. There was no statistical difference in CTG18.1 repeat lengths between failed corneal grafts and the geographically matched healthy control group. In conclusion, none of the nine failed corneal grafts in our material had CTG18.1 repeat lengths ≥ 31, a cut-off known to have a biological relevance in FECD. Thus, our results suggest that the assessment of donors and inspection of the corneal tissue before the decision for procurement is sufficient, in terms of recognizing FECD in the donor.
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Affiliation(s)
- Ida Maria Westin
- Department of Medical Biosciences, Medical and Clinical Genetics, Umeå University, Umeå, Sweden.
| | - Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| | - Irina Golovleva
- Department of Medical Biosciences, Medical and Clinical Genetics, Umeå University, Umeå, Sweden
| | - Berit Byström
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
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Deguchi H, Tanioka H, Watanabe M, Horiuchi N, Fukuoka H, Hieda O, Inatomi T, Kinoshita S, Sotozono C. Identification and Analysis of Primary Cilia in the Corneal Endothelial Cells of Patients with Bullous Keratopathy. Curr Eye Res 2024; 49:10-15. [PMID: 37706487 DOI: 10.1080/02713683.2023.2259633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To identify primary cilia in human corneal endothelial cells (CECs) obtained from patients with bullous keratopathy (BK). METHODS This study involved CEC specimens obtained from 10 eyes of 10 consecutive patients (three males and seven females; mean age: 74.5 years, range: 68-90 years) with BK who underwent Descemet's stripping automated endothelial keratoplasty at Baptist Eye Institute, Kyoto, Japan between August 2019 and September 2020. Three corneal buttons obtained from 3 patients who underwent penetrating keratoplasty for keratoconus were used as 'non-BK' controls. All specimens were evaluated with immunofluorescence staining using an antibody against acetylated α-tubulin. RESULTS Ciliary expression was observed in six of the 10 CEC specimens; i.e. in two specimens obtained from BK patients after glaucoma surgery (trabeculectomy), in two specimens obtained from patients with Fuchs endothelial corneal dystrophy, and in two specimens obtained from a patient with BK after laser iridotomy for primary angle closure. There was acetylated α-tubulin staining but no hair-like structures in two specimens, and ciliary expression was unknown in two specimens due to the absence of cells. The length of the primary cilia varied between all specimens. In contrast, no primary cilia were observed in the corneal buttons obtained from the three keratoconus patients. CONCLUSION The findings in this study clearly demonstrate the expression of primary cilia in the CECs of patients afflicted with BK.
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Affiliation(s)
- Hideto Deguchi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidetoshi Tanioka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mako Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Baptist Eye Institute, Kyoto, Japan
| | - Noriko Horiuchi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Inatomi
- Department of Ophthalmology, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Peraza-Nieves J, Sánchez-González JM, Rocha-de-Lossada C, Rachwani-Anil R, Sánchez-Valera M, Borroni D, Torras-Sanvicens J. Corneal densitometry patterns in Descemet membrane endothelial keratoplasty and Descemet stripping automated keratoplasty. Int Ophthalmol 2023; 43:4409-4417. [PMID: 33763796 DOI: 10.1007/s10792-021-01817-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare corneal densitometry in a consecutive series of 52 endothelial keratoplasties (DMEK/DSAEK) using a Scheimpflug-based device after six months of follow-up. METHODS Corneal densitometry (CD) values of 102 eyes were divided into three main groups: 33 DMEKs, 19 DSAEKs, and 50 healthy eyes without previous ocular surgery. The CD values were then analyzed and compared between the groups. We measured three main layers in depth and four different concentric zones at 1, 3, and 6 months postoperatively. RESULTS In the DMEK group, total CD significantly decreased from 38.02 ± 10.21 grayscale units (GSU) to 31.13 ± 9.25 GSU (P < 0.01) between the first and the sixth month postoperative. In the DSAEK group, we found significant changes only between the first and three months after surgery (from 42.62 ± 9.31 GSU to 38.71 ± 10.53 GSU (P < 0.01). Regarding the concentric zones, CD in the DMEK group significantly decreased in the central zone from 33.55 ± 12.07 GSU to 30.63 ± 10.15 GSU (P < 0.01) and significantly increased in the periphery from 30.63 ± 10.15 GSU to 36.72 ± 9.37 GSU, (P < 0.01). The DSAEK group showed no changes in the central zone (from 36.91 ± 13.80 GSU to 36.14 ± 11.47 GSU, P = 0.52) and CD significantly increased in the periphery (41.91 ± 9.28 GSU, P < 0.01). CONCLUSION When comparing CD values in DMEK versus DSAEK, we found no differences by layers or at central-paracentral concentric zones, although CD differences in the peripheral zones were statistically significant. This finding may be attributed to the thicker graft at periphery with a delayed clearance and less anatomical interphase in DSAEK.
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Affiliation(s)
- Jorge Peraza-Nieves
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Department of Ophthalmology, (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
| | - Rahul Rachwani-Anil
- Department of Ophthalmology, Regional University Hospital of Malaga, Malaga, Spain
| | - Miriam Sánchez-Valera
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
- Fondazione Banca Degli Occhi Del Veneto Onlus, Zelarino, Venezia, Italy
| | - Josep Torras-Sanvicens
- Department of Ophthalmology, Hospital Clinic de Barcelona Institut Clinic D'Oftalmologia, Barcelona, Spain
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Seth I, Bulloch G, Roberts PK, Vajpayee RB. Infectious crystalline keratopathy following Descemet's stripping automated endothelial keratoplasty. Eur J Ophthalmol 2023; 33:NP14-NP18. [PMID: 36484388 DOI: 10.1177/11206721221144655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
INTRODUCTION We describe this first case of Staphylococcus epidermidis causing infectious crystalline keratopathy (ICK) following Descemet stripping endothelial keratoplasty (DSAEK), that resolved after 5 weeks of topical antibiotic and corticosteroid treatment. CASE DESCRIPTION An 80-year-old woman presented with blurred vision, redness, and ocular pain 9 months after successful DSAEK. Slit lamp examination revealed the presence of white, non-suppurative, deep-branching stromal infiltrates, and a clinical diagnosis of ICK was made. Cultures of corneal scapings isolated multidrug-resistant Staphylococcus epidermidis. No subsequent surgical procedures were performed. Based on antibiotic sensitivity analysis, she was treated successfully with topical vancomycin and chloramphenicol for 5 weeks. Complete resolution of the infection with minor anterior stromal corneal scarring of the host cornea was noted after 5 weeks of treatment. This case report describes the diagnosis and management of ICK after DSAEK and reviews the relevant literature regarding the occurrence of ICK after DSAEK. CONCLUSION In this case, vancomycin and chloramphenicol allowed for the uncomplicated resolution of infection with only minor visual impairment from baseline.
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Affiliation(s)
- Ishith Seth
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Base Hospital, Bendigo, , Australia
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, , Australia
| | - Gabriella Bulloch
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Victoria, Australia
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, , Australia
| | - Philipp K Roberts
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Rasik B Vajpayee
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Victoria, Australia
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, , Australia
- Vision Eye Institute, Melbourne, Australia
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Coco G, Ferrara M, Borgia A, Romano D, Romano V. Carlevale intraocular lens opacification after Descemet stripping automated endothelial keratoplasty. Eur J Ophthalmol 2023; 33:NP60-NP62. [PMID: 36163691 DOI: 10.1177/11206721221128669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of sutureless scleral-fixated (SSF) Carlevale intraocular lens (IOL) opacification following Descemet stripping automated endothelial keratoplasty (DSAEK) surgery. METHODS An 82-year-old man underwent combined SSF Carlevale IOL implant and DSAEK surgery for aphakic endothelial decompensation. Surgery was uneventful, while the postoperative period was complicated by multiple graft detachments requiring re-bubbling. After four re-bubbling procedures, the corneal graft attached and cleared over time. RESULTS 29 months after combined SSF IOL implant and DSAEK surgery, the patient presented with decreased vision due to IOL opacification affecting the visual axis. CONCLUSION Although combined SSF IOL and DSAEK surgery is an overall safe and effective procedure for aphakic endothelial decompensation, risk of IOL opacification due to anterior chamber air injection is higher when using hydrophilic IOLs and in cases requiring multiple re-bubbling, therefore, intraocular lens material should be chosen after considering the risks and benefits.
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Affiliation(s)
- Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariantonia Ferrara
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Alfredo Borgia
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Davide Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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9
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Agarwal R, Shakarwal C, Sharma N, Titiyal JS. Concomitant sutureless scleral fixation of intraocular lens with keratoplasty: Review of surgical techniques. Indian J Ophthalmol 2023; 71:1718-1732. [PMID: 37203023 PMCID: PMC10391482 DOI: 10.4103/ijo.ijo_1724_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Sutureless scleral fixation of intraocular lens (sSFIOL) is a commonly employed method of optical rehabilitation of aphakic patients with deficient capsular support, and corneal transplant surgeries can be simultaneously combined with sSFIOL to handle aphakic corneal opacities. A single-stage procedure circumvents the need for repeat intraocular procedures and carries lower risk of graft endothelial damage, endophthalmitis, and macular edema associated with sequential surgeries. However, it mandates surgical expertise and increases the chances of postoperative inflammation. A basket of options is available with the corneal surgeons regarding the manner of host and donor preparation as well as the approaches to scleral fixation and certain intraoperative modifications along with postoperative vigilance may enhance the surgical outcomes. Most of the studies pertaining to keratoplasty with sSFIOL categorize to case reports/series, surgical techniques, and retrospective studies with very limited prospective data available currently. The purpose of the present review is to consolidate all available literature on concomitant sSFIOLs and keratoplasty procedures.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Chetan Shakarwal
- Department of Optometry, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
| | - Jeewan S Titiyal
- Department of Ophthalmology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India
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Khodeiry MM, Liu X, Sayed MS, Lee RK. Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation. Eur J Ophthalmol 2023:11206721221149514. [PMID: 36648194 DOI: 10.1177/11206721221149514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. METHODS Medical records of 47 patients (mean age of 70.7 ± 15.7 years and follow-up of 13.9 ± 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). RESULTS A statically significant reduction of IOP from 31.8 ± 8.0 mmHg preoperatively to 16.9 ± 9.0 mmHg postoperatively was noted (p < 0.001). Similarly, the number of glaucoma medications decreased from 4.0 ± 1.0 to 2.7 ± 1.4 (p < 0.001). The overall success rates at 12 and 24 months were 68.1% and 66.0%, respectively, with no difference in success rates between post-PKP and post-DSAEK subgroups (p = 0.836). No significant changes in VA or central corneal thickness (CCT) were observed (p = 0.345 and 0.311, respectively). One (3.3%) patient had a graft rejection. The majority of the complications noted during this study were mild and transient. CONCLUSIONS Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma.
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Affiliation(s)
- Mohamed M Khodeiry
- Department of Ophthalmology, Bascom Palmer Eye Institute, 22130University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiangxiang Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, 22130University of Miami Miller School of Medicine, Miami, Florida, USA.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mohamed S Sayed
- Department of Ophthalmology, Bascom Palmer Eye Institute, 22130University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, 22130University of Miami Miller School of Medicine, Miami, Florida, USA
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Kuzman T, Pupic-Bakrac A, Meter A, Gabric I, Gacina DL, Pauk SV, Jukic A, Skegro I, Masnec S, Kalauz M. Combined Cataract and Corneal Transplantation Surgery Without Viscosurgical Devices. Acta Inform Med 2023; 31:186-190. [PMID: 37781496 PMCID: PMC10540931 DOI: 10.5455/aim.2023.31.186-190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background The most common complications after performing the triple Descemet's stripping automated endothelial keratoplasty (DSAEK), which combines the cataract phacoemulsification, intraocular lens implantation and DSAEK procedure, are detachment or decentration of the donor lamella and postoperative interface haze. One reason for this is the retained viscoelastic used during surgery. Objective This study aimed to describe triple DSAEK procedure without the usage of viscoelastic and to discuss its potential benefits on surgical outcomes. Methods The surgical procedures and outcomes of patients with Fuchs' dystrophy and lens opacification who underwent the triple DSAEK were retrospectively reviewed. The surgical procedure was described, and postoperative complications were studied. Results The study included 10 eyes of 10 patients. Capsulorhexis and IOL implantation performed in locally potentiated anesthesia compared to general anesthesia did not significantly differ (P > 0,05). The mean preoperative best-corrected visual acuity was 0.75 LogMar. The mean postoperative best-corrected visual acuity was 0.2 LogMar. The central graft thickness before surgery was 129.6 μm and 6 months after surgery was 114.2 μm. Successful attachment of the donor lamellae was observed in all 10 patients. None of the patients had postoperative interface haze or any other possible viscoelastic caused complication. Conclusion Although viscoelastic can facilitate certain aspects of the triple DSAEK procedure, we conclude that this procedure can be performed completely without its use. If performed by a trained surgeon, the procedure can be feasible without the complications of donor lamella detachment, decentration, or interface haze.
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Affiliation(s)
- Tomislav Kuzman
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Pupic-Bakrac
- Department of Ophthalmology, University Hospital Dubrava, Zagreb, Croatia
| | - Ana Meter
- Department of Ophthalmology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivana Gabric
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Dina Lesin Gacina
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sania Vidas Pauk
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andjela Jukic
- Department of Ophthalmology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Skegro
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sanja Masnec
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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12
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Kitazawa K, Toda M, Ueno M, Uehara A, Sotozono C, Kinoshita S. The Biologic Character of Donor Corneal Endothelial Cells Influences Endothelial Cell Density Post Successful Corneal Transplantation. Ophthalmol Sci 2022; 3:100239. [PMID: 36846106 PMCID: PMC9944567 DOI: 10.1016/j.xops.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
Purpose Corneal endothelial cell density (ECD) gradually decreases after corneal transplantation by unknown biologic, biophysical, or immunologic mechanism. Our purpose was to assess the association between donor corneal endothelial cell (CEC) maturity in culture and postoperative endothelial cell loss (ECL) after successful corneal transplantation. Design Prospective cohort study. Participants This cohort study was conducted at Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. It included 68 patients with a 36-month follow-up period who had undergone successful Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty. Methods Human CECs (HCECs) from remaining peripheral donor corneas were cultured and evaluated for maturity by surface markers (CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Postoperative ECD was assessed according to the mature-differentiated HCEC contents: high-maturity group: > 70%, middle-maturity group: 10% to 70%, low-maturity group: < 10%. The successful rate of ECD maintained at 1500 cells/mm2 at 36 months postoperative was analyzed using the log-rank test. Main Outcome Measures Endothelial cell density and ECL at 36 months postoperative. Results The 68 included patients (mean [standard deviation] age 68.1 [13.6] years, 47.1% women, 52.9% DSAEK). The high, middle, and low-maturity groups included 17, 32, and 19 eyes, respectively. At 36 months postoperative, the mean (standard deviation) ECD significantly decreased to 911 (388) cells/mm2 by 66% in the low-maturity group, compared with 1604 (436) by 40% and 1424 (613) cells/mm2 by 50% in the high and middle-maturity groups (P < 0.001 and P = 0.007, respectively) and the low-maturity group significantly failed to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Additional ECD analysis for patients who underwent DSAEK alone displayed a significant failure to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Conclusions The high content of mature-differentiated HCECs expressed in culture by the donor peripheral cornea was coincident with low ECL, suggesting that a high-maturity CEC content predicts long-term graft survival. Understanding the molecular mechanism for maintaining HCEC maturity could elucidate the mechanism of ECL after corneal transplantation and aid in developing effective interventions. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- BK, bullous keratopathy
- CEC, corneal endothelial cell
- Corneal endothelial cell density
- Corneal transplantation
- Cultured corneal endothelial cells
- DSAEK
- DSAEK, Descemet stripping automated endothelial keratoplasty
- ECD, endothelial cell density
- ECL, endothelial cell loss
- Endothelial cell loss
- FACS, fluorescence-activated cell sorting
- HCEC, human CEC
- P, passage
- PK, penetrating keratoplasty
- SD, standard deviation
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Affiliation(s)
- Koji Kitazawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Munetoyo Toda
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Asako Uehara
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Shigeru Kinoshita
- Baptist Eye Institute, Kyoto, Japan,Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Correspondence: Shigeru Kinoshita, MD, PhD, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
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13
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Agarwal R, Shakarwal C, Sharma N, Titiyal JS. Intraoperative optical coherence tomography-guided donor corneal tissue assessment and preparation. Indian J Ophthalmol 2022; 70:3496-3500. [PMID: 36190034 PMCID: PMC9789831 DOI: 10.4103/ijo.ijo_1124_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the role of intraoperative optical coherence tomography (i-OCT) in donor grading, selection, and preparation during different types of keratoplasty. Methods Seventy-one consecutive donor corneas collected over 6 months, after clinical grading, were observed by an experienced corneal surgeon under an i-OCT equipped microscope. The donor preparation (manual/automated) for different types of keratoplasty procedures was also undertaken under i-OCT. Results The mean central corneal thickness of optical and nonoptical grade tissues was 533 ± 19 and 662 ± 52 μm, respectively. The i-OCT-based grading matched with clinical grading in 98.5% cases. Irregular thickness, anterior stromal hyperreflectivity, and previous scars were appreciated in 1.4, 1.4, and 7.04% donors, respectively. During Descemet stripping automated endothelial keratoplasty, i-OCT facilitated selection of appropriate microkeratome head for automated donor preparation in all cases, besides allowing manual dissection of partially dissected lenticule, identification of site of inadvertent perforation, and eccentric trephination in one case each. During Descemet membrane endothelial keratoplasty, i-OCT-based assessment of preexisting scar (five cases) guided careful tissue selection (2/5) and preparation. During predescemetic endothelial keratoplasty, precise needle advancement allowed successful type-1 bubble formation in all cases. All manually punched donors demonstrated an extra endothelial ledge, while those with automated preparation showed tapering donor margins. Conclusion i-OCT might serve as a useful imaging tool for objective assessment of donor characteristics. The modality may complement clinical evaluation for donor grading, selection, and preparation.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Dr. Rinky Agarwal, Cataract, Cornea and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | - Chetan Shakarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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14
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Li C, Wu W, Xiao G, Jhanji V, Hong J, Feng Y. Descemet Stripping Automated Endothelial Keratoplasty in Thick Corneas. J Clin Med 2022; 11. [PMID: 36233466 DOI: 10.3390/jcm11195601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the outcomes of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in corneas > 820 microns in thickness. Methods: This retrospective study included 30 eyes of 30 patients who underwent DSAEK. Endothelial cell destiny (ECD) and corneal thickness were recorded before surgery and at 1 and 12 months postoperatively. Patients were divided into two groups (≤ 820 microns and > 820 microns) based on median preoperative corneal thickness. Linear regression analyses were used to investigate the correlations between ECD and preoperative corneal thickness. Results: Recipient corneal thickness (RCT) and postoperative central cornea thickness had a statistically significant difference 1 month after surgery (p = 0.03, p = 0.08, respectively). BCVA and ECD did not have a statistical difference in the two groups at 1 month and 12 months after DSAEK. Conclusions: BCVA, ECD and corneal thickness were similar at 12 months after DSAEK in thick corneas. DSAEK is a viable surgical option in thick corneas.
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15
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Vanathi M, Raj N, Kusumesh R, Aron N, Gupta N, Tandon R. Update on Pediatric Corneal Diseases and Keratoplasty. Surv Ophthalmol 2022; 67:1647-1684. [PMID: 35918016 DOI: 10.1016/j.survophthal.2022.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022]
Abstract
Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties has expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers' compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children is further compromised by the pre-existing amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.
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Affiliation(s)
- Murugesan Vanathi
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India.
| | - Nimmy Raj
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Rakhi Kusumesh
- Cornea & Ocular Surface Services, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neelima Aron
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Noopur Gupta
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
| | - Radhika Tandon
- Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, India
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16
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Son HS, Lum F, Li C, Schein O, Pramanik S, Srikumaran D. Risk Factors for Repeat Keratoplasty after Endothelial Keratoplasty - an IRIS® Registry Analysis. Am J Ophthalmol 2022; 242:77-87. [PMID: 35738395 DOI: 10.1016/j.ajo.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess risk factors for repeat keratoplasty after endothelial keratoplasty (EK). DESIGN Retrospective cohort study METHODS: : EK procedures performed between 2013-2018 in the IRIS® Registry (Intelligent Research in Sight) were identified. STUDY POPULATION Patients aged 18 years and older who underwent EK. MAIN OUTCOME MEASURES 1) Risk factors for repeat keratoplasty, and 2) complication rates after EK. A Kaplan-Meier survival analysis was used to determine the probability of repeat keratoplasty. A multivariable shared frailty survival model was used to assess risk factors. RESULTS 59,344 procedures were identified in the registry, of which 30,600 EK procedures met the inclusion criteria for the analysis. The probability of repeat keratoplasty was 17.4% (95% CI:16.7-18.0%) at five years. Risk factors for repeat keratoplasty include post-operative re-bubbling procedure (HR 2.24, 95% CI:2.05-2.45); prior failed graft (HR 2.07, 95% CI:1.84-2.32) or bullous keratopathy (HR 1.47, 95% CI:1.33-1.61) versus Fuchs dystrophy as surgical indication; subsequent routine cataract surgery (HR 1.61, 95% CI:1.45-1.79); as well as subsequent (HR 1.53, 95% CI:1.39-1.69) and prior/concurrent (HR 1.23, 95% CI:1.11-1.36) glaucoma surgery or history of glaucoma (HR 1.24, 95% CI:1.14-1.35). Medicaid (HR 1.47, 95% CI:1.13-1.92), military/government (HR 1.29, 95% CI:1.03-1.60), Medicare Fee-for-Service (HR 1.17, 95% CI:1.05-1.31) or Medicare Managed (HR 1.17, 95% CI:1.01-1.36) insurances versus private insurance, as well as Black versus White race (HR 1.25, 95% CI:1.11-1.40) and smoking (HR 1.16, 95% CI:1.05-1.27) were also associated with an increased risk of undergoing repeat keratoplasty. CONCLUSIONS Black race, government-based insurance plans, and smoking were identified as independent factors associated with repeat keratoplasty in addition to history of glaucoma, glaucoma surgery, and prior graft failure or bullous keratopathy as surgical indication.
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Affiliation(s)
- Hyeck-Soo Son
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, CA
| | - Oliver Schein
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Divya Srikumaran
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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17
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Fisenko NV, Demura TA, Trufanov SV, Voronin GV. [Morphological characteristics of Descemet's membrane removed during endothelial keratoplasty (case study)]. Vestn Oftalmol 2022; 138:81-86. [PMID: 35488565 DOI: 10.17116/oftalma202213802181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The two most used modifications of endothelial keratoplasty (EK) are Descemet's membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK). The leading complication of EK surgeries is graft detachment in the early postoperative period. This article reports on two cases of endothelial graft adhesion depending on morphological characteristics of the Descemet's membrane (DM) removed during EK. In the first case, complete graft attachment to the recipient's posterior stroma was observed after DMEK. Morphological analysis of the DM showed clean stromal surface. In the second case there was a false chamber between the endothelial transplant and the posterior stroma of the patient. OCT scans revealed separate stromal fibers protruding into the false chamber; morphological analysis of the removed DM showed stromal fragments fixed to the anterior surface of the DM. The revealed changes indicate damage to the posterior stroma the suffered received during descemetorhexis, which may be the cause for incomplete graft attachment. Complete attachment after repeated EK (DSAEK) in this case was due to a thin stromal layer on the graft that provided high degree of adhesion to the posterior corneal surface. DSAEK can be indicated as a repeated EK surgery in cases of persistent endothelial graft non-attachment after DMEK.
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Affiliation(s)
- N V Fisenko
- Research Institute of Eye Diseases, Moscow, Russia
| | - T A Demura
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S V Trufanov
- Research Institute of Eye Diseases, Moscow, Russia
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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18
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Parekh M, Romano V, Hassanin K, Testa V, Wongvisavavit R, Ferrari S, Willoughby C, Ponzin D, Jhanji V, Sharma N, Daniels J, Kaye SB, Ahmad S, Levis H. Delivering Endothelial Keratoplasty Grafts: Modern Day Transplant Devices. Curr Eye Res 2022; 47:493-504. [PMID: 34986709 DOI: 10.1080/02713683.2021.2016852] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To summarize the graft loading, transporting and delivery devices used for endothelial keratoplasty (EK). METHODS A literature search of electronic databases was performed. RESULTS New techniques and devices have been introduced and implemented to prepare, load, transport and transplant the grafts for EK. The advantages are not only limited to the surgical theatre but also widely spread across the eye banking field. Investigation of advanced materials and designs have been rapidly growing with continuous evolution in the field of eye banking and corneal transplantation. Innovative techniques and modern devices have been evaluated to reduce the endothelial cell loss and increase the precision of the transplant in order to benefit both surgeons and the patients. CONCLUSIONS It is extremely important to reduce any potential wastage and optimize the use of every available donor cornea due to the limited availability of healthy cadaveric donor corneas required for transplants. As a result, the use of pre-cut and pre-loaded grafts supplied by the eye banks in calibrated devices have been gaining momentum. Innovation in the field of bioengineering for the development of new devices that facilitate excellent clinical outcomes along with reduction in learning curve has shown promising results.
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Affiliation(s)
- Mohit Parekh
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vito Romano
- St.Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion on Oftalmologica, Oviedo, Spain
- Institute of Life Course and Medical Sciences, Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Kareem Hassanin
- St.Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK
| | - Valeria Testa
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
- Department of Ophthalmology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Rintra Wongvisavavit
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
- HRH Princess Chulabhorn College of Medical Sciences, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | | | - Diego Ponzin
- International Center for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Julie Daniels
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
| | - Stephen B Kaye
- St.Paul's Eye Unit, Royal Liverpool Broadgreen University Hospital, Liverpool, UK
| | - Sajjad Ahmad
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
- Cornea, cataract and external eye diseases, Moorfields Eye Hospital NHS Trust Foundation, London, UK
| | - Hannah Levis
- Institute of Life Course and Medical Sciences, Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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19
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Fisenko NV, Trufanov SV, Demura TA. [Morphological features of the cornea in eyes with pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy]. Vestn Oftalmol 2022; 138:31-37. [PMID: 35234418 DOI: 10.17116/oftalma202213801131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the morphological features of posterior corneal layers in pseudophakic bullous keratopathy (PBK) and Fuchs endothelial corneal dystrophy (FECD). MATERIAL AND METHOD The study included 20 patients (20 eyes) aged 73.8±7.8 with PBK and 24 patients (25 eyes) aged 72.5±10.6 with FECD. Central corneal thickness was measured in all eyes before the surgery by anterior segment optical coherence tomography (AS-OCT, RTVue-100, Optovue, USA). All patients underwent corneal transplantation (DSAEK or DMEK). Postoperative donor graft status was assessed as attached or detached by AS-OCT (RTVue-100, Optovue, USA). Specimens of Descemet's membranes (DMs) were obtained intraoperatively and investigated histologically (hematoxylin and eosin staining). Morphometric analysis was performed using optical microscope Leica DM-2500 (Digital Color Camera Leica DFC295) and ImageScope M software. RESULTS There was no difference in thickness of DMs' prenatal anterior banded layer (2.58±0.49 μm) and postnatal posterior non-banded layer (11.30±2.64 μm) between PBK and normal cornea. In FECD eyes, DM was significantly thickened by additional collagen layer and guttate excrescences (postnatal layer thickness - 16.62±4.34 μm). Morphological study of the DMs of patients with graft detachment in the early postoperative period revealed residual stromal collagen fibrils that were fixed to the area with dense extracellular matrix. CONCLUSION The study shows that chronic corneal edema is associated with pathological morphological changes in the posterior corneal layers in PBK and FECD. Individual features of the dense extracellular matrix in the DMs may play a key role in the attachment of donor graft to the corneal stroma and affect the postoperative outcome.
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Affiliation(s)
- N V Fisenko
- Research Institute of Eye Diseases, Moscow, Russia
| | - S V Trufanov
- Research Institute of Eye Diseases, Moscow, Russia
| | - T A Demura
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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20
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Romano V, Parekh M, Kazaili A, Steger B, Akhtar R, Ferrari S, Kaye SB, Levis HJ. Eye bank versus surgeon prepared Descemet stripping automated endothelial keratoplasty tissues: Influence on adhesion force in a pilot study. Indian J Ophthalmol 2022; 70:523-528. [PMID: 35086230 PMCID: PMC9023930 DOI: 10.4103/ijo.ijo_3637_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/06/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate and compare the biomechanical properties of the eye bank-prepared and surgeon prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. METHODS In this laboratory study, corneal tissues for research were randomly allocated in the following groups: a) surgeon-cut DSAEK and b) eye bank-prepared (pre-cut and pre-loaded) DSAEK. Endothelial cell loss (ECL), immunostaining for tight junction protein ZO-1, elastic modulus, and adhesion force were investigated. RESULTS ECL was not found to be significantly different between surgeon-cut DSAEK (7.8% ±6.5%), pre-cut DSAEK (8.6% ±2.3%), and pre-loaded DSAEK (11.1% ±4.8%) (P = 0.5910). ZO-1 was expressed equally across all groups. Surgeon-cut DSAEK grafts showed a significantly higher elastic modulus compared to pre-cut and pre-loaded DSAEK groups (P = 0.0047 and P < 0.0001, respectively). Adhesion force was significantly greater in the surgeon-cut DSAEK compared to pre-cut (P < 0.0001) or pre-loaded DSAEK groups (P = 0.0101). CONCLUSION The laboratory data on the biomechanics of DSAEK grafts suggests that surgeon-cut DSAEK grafts present higher elastic modulus and adhesion force compared to eye bank-prepared DSAEK grafts.
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Affiliation(s)
- Vito Romano
- St. Paul’s Eye Unit, Royal Liverpool University Hospital London, London, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
| | - Mohit Parekh
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK
| | - Ahmed Kazaili
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool London, London, UK
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah, Iraq
- Babylon Health Directorate, Ministry of Health, Babylon, Iraq
| | - Bernhard Steger
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | - Riaz Akhtar
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool London, London, UK
| | - Stefano Ferrari
- International Centre for Ocular Physiopathology, Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Stephen B Kaye
- St. Paul’s Eye Unit, Royal Liverpool University Hospital London, London, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool London, London, UK
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21
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Weisenthal RW, Yin HY, Jarstad AR, Wang D, Verdier DD. Long-term Outcomes in Fellow Eyes Comparing DSAEK and DMEK for Treatment of Fuchs Corneal Dystrophy. Am J Ophthalmol 2022; 233:216-226. [PMID: 34157279 DOI: 10.1016/j.ajo.2021.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the long-term results of Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) in fellow eyes for treatment of Fuchs endothelial corneal dystrophy. METHODS This study is a 2-centered, retrospective case series of 64 patients (128 eyes) with DSAEK followed by DMEK. The main outcomes measured were best spectacle-corrected visual acuity (BSCVA) and duration of time to achieve BSCVA as well as eye preference. RESULTS Preoperative median logarithm of the minimum angle of resolution (logMAR) BSCVA was similar in eyes receiving DMEK 0.36 ± 0.26 and DSAEK 0.42 ± 0.34 (P = .266). The average follow-up time needed for the DMEK eyes to achieve BSCVA was faster than that of DSAEK (277 days vs 490 days, P = .0014). With long-term follow-up, the BSCVA of the DMEK eyes [0.09 ± 0.10 logMAR] and DSAEK eyes [0.11 ± 0.16 logMAR] did not show a statistically significant difference (P = .069). Twenty-two of the 64 preferred the DMEK eye, 17 patients preferred the DSAEK eye (P = .423), and 25 patients did not have a preference. In the DMEK group, the average spherical equivalent was -0.08 compared with the DSAEK group at 0.06 (P = .2854). CONCLUSION In our fellow eye study with long-term follow-up, DMEK and DSAEK had comparable levels of BSCVA and patient satisfaction. The DMEK eyes reached their BSCVA sooner, whereas the DSAEK eyes improved over a longer time frame. A greater number of patients had 20/25 and 20/20 vision in the DMEK group; however, the difference was not statistically significant. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Robert W Weisenthal
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York.
| | - Han Y Yin
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Allison R Jarstad
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York
| | - Dongliang Wang
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York
| | - David D Verdier
- Department of Surgery, Ophthalmology Division Michigan State University College of Human Medicine Eye Grand Rapids Michigan Verdier Center, Grand Rapid, Michigan, USA
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22
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Narayanan N, Jain N, Ravi P, Natarajan V. The outcome of 70/30 taco insertion through a 2.8 mm clear corneal incision in Descemet's stripping automated endothelial keratoplasty - A retrospective analysis. Indian J Ophthalmol 2021; 70:95-99. [PMID: 34937216 PMCID: PMC8917581 DOI: 10.4103/ijo.ijo_663_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To assess the long-term outcome of graft insertion by taco technique through a 2.8-mm clear corneal incision in patients undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK). Methods: This is a retrospective interventional case series of 77 eyes of 75 patients who underwent DSAEK in a tertiary eye hospital. The DSAEK donor grafts were folded to an uneven 70/30 taco and held at a single point using Utrata forceps. All insertions were through a 2.8-mm clear corneal incision except the two aphakic patients requiring combined SFIOL implantation. All patients underwent a comprehensive eye examination preoperatively and were followed up to 6 years postoperatively. Visual outcomes, graft clarity, and complications of all and endothelial cell loss in 22 patients with available postop specular microscopy were analyzed. Results: Overall, 59 (76.6%) had clear grafts until the final follow-up. Visual acuity improved in 48 (62.3%) from an average of 1.3 to 0.8 logMAR (P = 0.0001). Vision was maintained in seven and worsened in four eyes. Grafts failed in 18 (23.3%) eyes: seven (9%) were primary failures, two post rejection, four done for failed PK did not clear, four due to worsening of preexisting glaucoma, and one noncompliant failed eventually. Average endothelial cell density reduction was 26.3% (mean preop donor 2419 to postop 1779 cells/mm2; P = 0.000). Conclusion: Our study shows good long-term clinical outcome of DSAEK using Taco technique through a 2.8-mm clear corneal incision in a tertiary hospital.
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Affiliation(s)
- Niveditha Narayanan
- Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nikhila Jain
- Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Praneesh Ravi
- Department of Cornea and Refractive Services and Biostatistician, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Viswanathan Natarajan
- Statistician, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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23
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Mohebbi M, Mehrpour M, Sanij AD, Mohammadi N, Mirghorbani M. Pediatric endothelial keratoplasty: a systematic review and individual participant data meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34709453 DOI: 10.1007/s00417-021-05459-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recently, endothelial keratoplasty (EK) has been increasingly considered the first intervention in pediatrics with isolated corneal endothelial dysfunction. This systematic review aims to investigate the current evidence about the advantages, disadvantages, technical challenges, and clinical outcomes of EK in the pediatric group. METHOD All the English literature relevant to pediatric EK was searched in PubMed, Embase, Scopus, and Cochrane databases with appropriate keywords. Relevant data were pooled to conduct an individual participant data meta-analysis. RESULTS Of 1646 articles found initially, 35 articles were finally eligible to be included in our study. A total of 154 eyes of 107 patients underwent Descemet's stripping automated endothelial keratoplasty (DSAEK). Congenital hereditary endothelial dystrophy (CHED) was the most reported indication for pediatric DSAEK (108 eyes). Descemet's membrane endothelial keratoplasty (DMEK) was performed in 2 eyes of 2 cases, one with PPCD and another one in a patient with Kearns-Sayre syndrome. Owing to some specific anatomical and physiological pediatric characteristics, some modifications in a standard procedure were suggested. The average follow-up period was 23.80 ± 20.18 months (3 months to 8.5 years). Seventy-six eyes who had a mean best-corrected visual acuity (BCVA) of 1.36 ± 0.70 (0.49 to 3) logMAR preoperatively found mean BCVA of 0.51 ± 0.33 (0.04 to 2) logMAR postoperatively. Graft dislocation was the most reported complication (26 eyes). The rate of other complications was low. Endothelial cell loss was reported from 8.3 to 63.7% after pediatric EK with follow-up duration from 3 months to 8.3 years. CONCLUSION EK procedures, despite some technical challenges, are feasible surgical techniques with acceptable visual and anatomical outcomes in the management of pediatrics with corneal endothelial dysfunction and minimal stromal involvement.
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24
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Roberts HW, Gunasekera CD, Law EM, Seifelnasr M, Giannaccare G, Busin M, Myerscough J. Sutureless Tectonic Mini-Descemet's Stripping Automated Endothelial Keratoplasty ("mini- DSAEK") for the management of corneal perforations. Eur J Ophthalmol 2021; 32:2133-2140. [PMID: 34657450 DOI: 10.1177/11206721211050034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the outcomes of a new technique, pull-through sutureless 'mini-DSAEK', to manage corneal perforations secondary to different aetiologies including trauma, neurotrophic ulcer following penetrating keratoplasty (PK), herpes simplex keratitis and microbial keratitis. METHODS In this retrospective case series, we report the clinical outcomes of five cases of sutureless tectonic mini-DSAEK performed in patients presenting with large corneal perforations to Southend University Hospital between November 2019 and October 2020. One corneal perforation was sufficiently peripheral for the tectonic mini-DSAEK graft to be successfully positioned outside of the central visual axis. Four corneal perforations were central or paracentral for which the tectonic grafts involved the visual axis. RESULTS Anterior chambers remained deep and formed with no evidence of leak in all subsequent follow ups in all patients representing 100% tectonic success. All tectonic grafts remained attached except one partially detached graft. One patient underwent uneventful phacoemulsification with intraocular lens implant 8 months after the primary intervention with excellent visual outcome. Two patients underwent two-piece mushroom PK and one patient underwent triple procedure (cataract extraction + intraocular lens + PK) for visual rehabilitation 2-6 months after the primary intervention with good visual outcome. CONCLUSION Sutureless tectonic pull-through mini-DSAEK is a useful technique in the management of corneal perforations, with a number of advantages compared with conventional techniques.
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Affiliation(s)
- Harry W Roberts
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK
| | | | - Elizabeth M Law
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK
| | - Mohamed Seifelnasr
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK.,Department of Ophthalmology, 54562Alexandria University, Alexandria, Egypt
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Massimo Busin
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Morphology, Surgery and Experimental Medicine, Ferrara, Italy
| | - James Myerscough
- Department of Ophthalmology, 575019Southend University Hospital, Southend, UK.,Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
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25
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Gómez‐Benlloch A, Montesel A, Pareja‐Aricò L, Mingo‐Botín D, Michael R, Barraquer RI, Alió J. Causes of corneal transplant failure: a multicentric study. Acta Ophthalmol 2021; 99:e922-e928. [PMID: 33421330 DOI: 10.1111/aos.14708] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify the causes of failure of the different surgical corneal graft techniques: penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS This multicentric retrospective study enrolled a consecutive cohort of patients who had undergone any type of keratoplasty between 2001 and 2016. The clinical data were obtained from the patient's medical records, following ethical guidelines, permissions and data protection. The main outcome measured in the study was the cause of graft failure, defined as any irreversible loss of graft transparency capable of compromising vision. The main causes of graft failure were classified as follows: (A) primary graft failure (PGF), (B) immunological rejection, (C) non-rejection (which includes endothelial decompensation without rejection, IOP elevation/glaucoma, diseases of the ocular surface, recurrence of the primary disease, wound dehiscence/hypotonia and trauma, among others) and (D) specific causes of lamellar keratoplasty failure. A descriptive study of the obtained data was carried out. The distribution of the causes of failure was evaluated according to the type of corneal transplant. RESULTS Our research included a cohort of 571 keratoplasty failures, of which 509 met the inclusion criteria. The analysis of the causes of the PK failure showed that immunological allograft rejection represented the main cause, with 28.2% of the failures, followed by surface diseases (17.8%) and endothelial decompensation without rejection (17.3%). For the PK re-grafts group, the main cause of failure was immunological allograft rejection (34.0%), followed by diseases of the ocular surface (18.5%). For the DALK group, the failures mainly occurred due to surface diseases such as limbal stem cell insufficiency, infectious keratitis, keratolysis or persistent epithelial defect (37.8%). However, the main reason for failure in the DSAEK group was endothelial decompensation without rejection (31.9%) while primary graft failure was the main cause of failure in the DMEK group (64.1%). CONCLUSION The main reason for failure in PK was immunological allograft rejection, both in primary and secondary transplants. The leading causes for failure were diseases of the ocular surface in the DALK population, endothelial decompensation without rejection in DSAEK and primary graft failure in DMEK.
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Affiliation(s)
- Alba Gómez‐Benlloch
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
| | | | - Luis Pareja‐Aricò
- Hospital Clínico Universitario de Valladolid Universidad de Valladolid Valladolid Spain
| | | | - Ralph Michael
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
| | - Rafael I. Barraquer
- Centro de Oftalmología Barraquer Barcelona Spain
- Institut Universitari Barraquer Universitat Autònoma de Barcelona Barcelona Spain
- Universitat Internacional de Catalunya Barcelona Spain
| | - Jorge Alió
- Vissum Miranza Alicante Spain
- Division of Ophthalmology Universidad Miguel Hernández Alicante Spain
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26
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Shah P, Mukhija R, Gupta N, Vanathi M, Tandon R. Cost-effectiveness of Descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in patients with endothelial dysfunction in India. Indian J Ophthalmol 2021; 69:2447-2451. [PMID: 34427242 PMCID: PMC8544062 DOI: 10.4103/ijo.ijo_2314_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this study was to compare the cost-effectiveness and perform cost-utility analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) vs. penetrating keratoplasty (PK) in Indian population. Methods: This was an institutional, ambispective, observational study. Patients who underwent PK or DSAEK for endothelial dysfunction were included and followed up for 2 years; those with other ocular comorbidities were excluded. The analysis was performed from the patient’s perspective receiving subsidized treatment at a tertiary care hospital. Detailed history, ophthalmic examination, total expenditure by patient, and clinical outcomes were recorded. The main outcome measures were best spectacle-corrected visual acuity (BSCVA), graft survival (Kaplan–Meier survival estimates), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Utility values were based on quality-adjusted life years (QALYs) associated with visual acuity outcomes. Statistical analysis was performed using SPSS software package, version 12.1; a value of P < 0.05 was considered statistically significant. Results: A total of 120 patients (PK: 60, DSAEK: 60) were included. At 2 years, for a similar logMAR BSCVA, [PK (0.32 ± 0.02), DSAEK (0.25 ± 0.02); P = 0.078], the overall cost for PK (13511.1 ± 803.3 INR) was significantly more than DSAEK (11092.9 ± 492.1 INR) (difference = 1952.6 INR; P = 0.01). ICER of DSAEK relative to PK was –39,052 INR for improvement in 1 logMAR unit BSCVA. ICUR of DSAEK relative to PK was –1,95,260 INR for improvement in 1 QALY. Conclusion: DSAEK was more cost-effective than PK in patients with endothelial dysfunction at 2 years.
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Affiliation(s)
- Pooja Shah
- Cornea, Cataract and Refractive Surgery, Ocular Oncology and Low Vision Services (Unit 6), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Mukhija
- Cornea, Cataract and Refractive Surgery, Ocular Oncology and Low Vision Services (Unit 6), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea, Cataract and Refractive Surgery, Ocular Oncology and Low Vision Services (Unit 6), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M Vanathi
- Cornea, Cataract and Refractive Surgery, Ocular Oncology and Low Vision Services (Unit 6), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Cataract and Refractive Surgery, Ocular Oncology and Low Vision Services (Unit 6), Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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27
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Pagano L, Gadhvi KA, Parekh M, Coco G, Levis HJ, Ponzin D, Ferrari S, Virgili G, Kaye SB, Edwards RT, Romano V. Cost analysis of eye bank versus surgeon prepared endothelial grafts. BMC Health Serv Res 2021; 21:801. [PMID: 34384422 PMCID: PMC8359056 DOI: 10.1186/s12913-021-06828-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Background Selective lamellar corneal transplantation (keratoplasty) has overtaken full thickness penetrating keratoplasty as the graft choice for endothelial failure. Even more recently eye bank prepared tissues are becoming increasing popular as a way to reduce the risks of tissue loss and stress during endothelial keratoplasty preparation in the surgical theatre. This study compares costs between surgeon and eye bank prepared tissues for Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Methods Retrospective study conducted at the Royal Liverpool University Hospital including endothelial keratoplasties with a minimum of 6 months follow-up time. Cost analysis included surgical expenses, tissue acquisition fees, cost of patient’s ward admission and out-patient expenses, including cost of re-bubbling procedures, costs of visits, anterior segment imaging and optometrist visits within the first 6 months follow-up. Results Ninety-eight eyes of 98 patients were included in the study of which 42 underwent DSAEK surgery and 56 DMEK surgery. Cost analysis of surgical expenses in the DSAEK group showed a significant difference between using surgeon prepared and eye bank prepared tissue (£3866 ± 296 and £4389 ± 360, respectively; p < 0.01) and the same was found in the DMEK group (£3682 ± 167 and £4162 ± 167 for surgeon prepared and eye bank prepared tissues, respectively; p < 0.01). Cost of out-patient visits did not differ significantly in either group. Conclusions At the Royal Liverpool University Hospital, eye bank prepared tissues had higher surgical expenses compared to those prepared by the surgeon, while the post-operative care expenses were similar between the two groups.
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Affiliation(s)
- Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Kunal A Gadhvi
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Venice Eye Bank Foundation, Venice, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Venice Eye Bank Foundation, Venice, Italy
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Stephen B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.,Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Rhiannon T Edwards
- Department of Public Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. .,Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK. .,Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain. .,Department of Corneal and External Eye Diseases, St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK.
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28
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Asif MI, Bafna RK, Sharma N, Kaginalkar A, Sinha R, Agarwal T, Maharana PK, Kaur M, Taank P, Titiyal JS. Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy. Clin Ophthalmol 2021; 15:3173-3181. [PMID: 34349494 PMCID: PMC8326941 DOI: 10.2147/opth.s300286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) in congenital hereditary endothelial dystrophy (CHED) and to evaluate the role of microscope integrated optical coherence tomography (Mi-OCT) during the surgery. Design Retrospective data analysis. Methods A retrospective study from the medical records of all those patients who were diagnosed with CHED and underwent DSAEK at our centre from 2015 were evaluated. All patients underwent Mi-OCT-guided standard DSAEK procedure. Intra-operative difficulties, visual outcomes and graft survival were recorded. Results A total of 48 eyes of 29 patients with a mean age of 9.87 ± 8.2 years and mean follow-up of 17.3 months were evaluated. Thirty-nine eyes underwent primary DSAEK and 9 eyes underwent PKP. Three eyes who underwent PKP had failed graft for which they underwent DSAEK. The mean preoperative Snellen's visual acuity was 1.71 ± 0.66 and the mean preoperative central corneal thickness was 1.10 ± 0.174 mm. Intraoperatively, all the grafts were attached which was confirmed using Mi-OCT. Graft detachment was seen in the immediate postoperative period in 10.4% (4 eyes) of primary DSAEK, out of which DM scoring was not performed in 2 eyes. Following DSAEK, cornea cleared at four-week follow-up in 89.7% eyes and in all the eyes the cornea cleared at six-week follow-up. Conclusion Primary DSAEK could be a preferred option over PKP for CHED with early presentation and in those eyes with failed primary PKP. Mi-OCT is a very useful tool in these eyes for various intraoperative procedures, thereby improving the outcomes of the procedure.
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Affiliation(s)
- Mohamed Ibrahime Asif
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ananya Kaginalkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Taank
- Department of Ophthalmology, Command Hospital, Pune, 411040, India
| | - Jeewan S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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29
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Anders LM, Gatzioufas Z, Grieshaber MC. Challenges in the complex management of post-keratoplasty glaucoma. Ther Adv Ophthalmol 2021; 13:25158414211031397. [PMID: 34350382 PMCID: PMC8295943 DOI: 10.1177/25158414211031397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.
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Affiliation(s)
- Lisa-Marie Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
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30
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Wu J, Wu T, Li J, Wang L, Huang Y. DSAEK or DMEK for failed penetrating keratoplasty: a systematic review and single-arm meta-analysis. Int Ophthalmol 2021; 41:2315-2328. [PMID: 34117964 DOI: 10.1007/s10792-021-01778-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the published literature on indications and outcomes of DSAEK/DSEK and DMEK for the treatment of failed penetrating keratoplasty. DESIGN This is a systematic review and single-arm meta-analysis. METHODS Literature searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Prospective and retrospective studies reporting DSAEK/DSEK or DMEK after failed penetrating keratoplasty were included. Primary outcome measures are graft survival and detachment rates, as well as postoperative visual outcomes. RESULTS A total of 25 studies with 970 patients/989 eyes were included, comprising 735 patients with 746 eyes which underwent DSAEK/DSEK surgery and 235 patients with 243 eyes which underwent DMEK surgery, all of them following a previously failed PK. There were no randomized controlled studies. In all of the DSAEK-PK studies, the graft failure rate was 18% (10%, 26%), the detachment rate was 15% (9%, 22%) and the rejection rate was 7% (3%, 12%) by the time of the last follow-up. And in all of the DMEK-PK studies, the graft failure rate was 14% (4%, 27%), the detachment rate was 42% (28%, 56%) and the rejection rate was 7% (2%, 16%). The mean visual acuity of the DSAEK-PK and DMEK-PK groups is 0.65 ± 0.18 and 0.43 ± 0.23 logMAR, respectively, at 6 months postoperatively. CONCLUSIONS Endothelial keratoplasty for treatment of failed penetrating keratoplasty led to improved vision and graft clarity in most recipients. Though graft survival rates and rejection rates were comparable between the two groups, the DMEK-PK group showed better visual outcomes with higher detachment rate.
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Affiliation(s)
- Jie Wu
- Department of Ophthalmology, the Third Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Tengyun Wu
- Department of Ophthalmology, the Third Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Jianhang Li
- Hospital of the 61150 Troop of Chinese PLA, Yulin, Shannxi, China
| | - Liqiang Wang
- Department of Ophthalmology, the Third Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Yifei Huang
- Department of Ophthalmology, the Third Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Droutsas K, Alexopoulos P, Giachos I, Giallouros E, Sekundo W, Lazaridis A. Secondary DMEK following failed primary DMEK. Int Ophthalmol 2021; 41:3287-3293. [PMID: 34076784 DOI: 10.1007/s10792-021-01890-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) performed for failed primary DMEK. METHODS The medical records of all patients undergoing secondary DMEK due to failure of primary DMEK were reviewed. Reasons for failure were sought and best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications of secondary DMEK were evaluated. RESULTS A total of 10 cases undergoing secondary DMEK following failed primary DMEK were identified. Presumed reasons for failure included donor ECD ≤ 2300 cells/mm2 (n = 4), difficulty during graft preparation (n = 2), graft detachment (n = 2), acute angle closure due to retroiridal air dislocation (n = 1), inverse graft positioning (n = 1) and phacoemulsification (n = 1). Eyes with low visual potential were not excluded from the study group. We should note that one patient (case no7) had both low ECD and graft detachment as reasons for failure and as a result he is counted twice. Median BCVA (decimal fraction) increased from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at the final follow-up. Mean ECD fell from 2628 ± 284 cells/mm2 to 1391 ± 252cells/mm2 at 6 months (47% reduction) and 959 ± 225cells/mm2 at 24 months (64% reduction) (P ≤ 0.028). Complications included the incomplete removal of the primary graft and mild iris bleeding, decompensation of a preexisting primary open-angle glaucoma and retroiridal air dislocation. CONCLUSIONS Apart from low donor ECD, surgical challenges, i.e., difficulty with graft preparation, inverse graft positioning, and retroiridal air dislocation, were main reasons for failure of primary DMEK. Secondary DMEK showed a good safety profile and reasonable visual outcomes.
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Affiliation(s)
- Konstantinos Droutsas
- First Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece.,Department of Ophthalmology, Philipps University, 35043, Marburg, Germany
| | - Palaiologos Alexopoulos
- First Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Ioannis Giachos
- First Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, 11527, Athens, Greece.
| | | | - Walter Sekundo
- Department of Ophthalmology, Philipps University, 35043, Marburg, Germany
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32
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Elalfy M, Maqsood S, Soliman S, Hegazy SM, Hannon AA, Gatzioufas Z, Lake D, Hamada S. Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty. Clin Ophthalmol 2021; 15:2179-2188. [PMID: 34079216 PMCID: PMC8164721 DOI: 10.2147/opth.s299098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation >21mmHg or ≥6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity. Results The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP>16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP>16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status. Conclusion Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP>16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.
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Affiliation(s)
- Mohamed Elalfy
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Eye Department, Maidstone and Turnbridge Wells Hospital, Maidstone, UK.,Research Institute of Ophthalmology, Giza, Egypt
| | - Sundas Maqsood
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | | | | | | | - Zisis Gatzioufas
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Eye Department, University Hospital Basel, Basel, Switzerland
| | - Damian Lake
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Samer Hamada
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Pagano L, Gadhvi KA, Coco G, Fenech M, Titley M, Levis HJ, Ruzza A, Ferrari S, Kaye SB, Parekh M, Romano V. Rebubbling rate in preloaded versus surgeon prepared DSAEK. Eur J Ophthalmol 2021; 32:11206721211014380. [PMID: 33947232 DOI: 10.1177/11206721211014380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the clinical outcomes of eye bank preloaded Descemet stripping automated endothelial keratoplasty (DSAEK) grafts and surgeon prepared. METHODS In this retrospective study, the data were obtained from two groups (a) surgeon cut DSAEK where tissue was prepared by the surgeon immediately before surgery, and (b) preloaded DSAEK tissue shipped to the surgeon after preparation by the eye bank. Standard DSAEK preparations using Moria microkeratome with single pass method were performed. For the tissues prepared by the eye banks, they were preloaded in an iGlide device and shipped in transport media. Standard DSAEK surgery using bimanual pull-through technique was performed for all the grafts. Air was used as a tamponade. Main outcome measures included best corrected visual acuity (BCVA) and rebubbling rate. RESULT Out of 107 eyes of 101 patients that underwent DSAEK surgery, 33 tissues were prepared by the surgeon (sc-DSAEK), while 74 were prepared by the eye bank (pl-DSAEK). sc-DSAEK showed a rebubbling rate of 9.1%, compared to the 16.2% for the preloaded DSAEK (p = 0.11). There was no statistical difference in postoperative BCVA between the two groups. Logistic regression analysis showed no association between detachment rate and cataract surgery, graft preparation method, graft diameter and reason for graft. CONCLUSION Preloaded grafts have similar rebubbling rate and visual acuity achieved compared with surgeon prepared grafts.
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Affiliation(s)
- Luca Pagano
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Giulia Coco
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Mitchell Titley
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto Onlus, Venice, Italy
| | - Stephen B Kaye
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Vito Romano
- The Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo and Fundacion de Investigacion Oftalmologica, Oviedo, Spain
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34
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Karadag R, Hammersmith KM, Nagra PK, Rapuano CJ. Anterior Chamber Characteristics, Endothelial Parameters, and Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Fuchs Dystrophy. J Ophthalmic Vis Res 2021; 16:158-164. [PMID: 34055252 PMCID: PMC8126739 DOI: 10.18502/jovr.v16i2.9078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye. Methods This prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups. Results The mean age of the patients was 76.9 ± 7.0 years. There were no statistically significant differences in the mean central corneal thickness (CCT), central anterior chamber depth, anterior chamber angle parameters, cylinder and keratometry values between two groups (all P-values > 0.05). The paracentral corneal thickness, corneal volume, endothelial cell density, and hexagonal cell ratio measurements were statistically significantly higher in the DSAEK group than the control (all P-values < 0.05), and anterior chamber volume in the DSAEK group was significantly less than the control (P = 0.046). While posterior and total corneal densitometry values in the DSAEK group were statistically significantly lower than the control (P < 0.001 and P = 0.011, respectively), there were no statistically significant differences in the anterior or middle corneal densities (P = 0.108 and P = 0.134, respectively). Conclusion We found that total corneal densitometry value decreased in DSAEK group. Although DSAEK surgery did not affect the anterior chamber angle parameters, it reduced the anterior chamber volume and increased the corneal volume and paracentral corneal thickness due to the addition of the DSAEK graft.
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Affiliation(s)
| | - Kristin M Hammersmith
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Parveen K Nagra
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
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Trufanov SV, Voronin GV, Sukhanova EV, Sukhanov TR. [Comparative assessment of functional outcomes of different endothelial keratoplasty techniques]. Vestn Oftalmol 2021; 137:43-50. [PMID: 33881262 DOI: 10.17116/oftalma202113702143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Comparative analysis of the higher-order aberrations (HOA) of the cornea after endothelial keratoplasty (EK) using DSAEK and DMEK techniques; evaluation of the correlation between higher-order corneal aberrations and functional outcomes of the treatment. MATERIAL AND METHODS The study included 47 patients (59 eyes). The main group consisted of 35 patients (35 eyes) with bullous keratopathy and Fuchs' endothelial dystrophy; among them, 19 patients underwent endothelial keratoplasty using the DSAEK technique and 16 - DMEK technique. The control group included 12 patients (24 eyes) of corresponding age without corneal pathology. Standard and special examination tests were performed before, as well as 6 and 12 months after the operation, including computed tomography and aberrometry of the cornea using the Pentacam HR system. Same tests were performed in the control group. RESULTS The values of the main HOA of the anterior corneal surface: RMS coma (Z3±1, Z5±1), RMS spherical aberration (SA; Z40, Z60) and RMS HOA (Z3-6) 6 months after different EK techniques were statistically significantly higher than in the control group. A statistically significantly lower induction of aberrations of the posterior corneal surface after DMEK technique was revealed. Analysis of the final aberration pattern 6 months after surgery did not reveal any statistically significant differences in the values of the main (RMS coma, RMS SA, RMS HOA) total corneal aberrations after DSAEK and DMEK. A negative correlation was revealed between the best corrected visual acuity (BCVA) and HOA; however, it was statistically significant only for individual aberration values: RMS HOA (Z3-6) of the posterior corneal aberrations after DMEK (r= -0.634, p=0.049), and RMS coma (Z3±1, Z5±1) of the cornea after DSAEK (r= -0.57, p=0.042). CONCLUSION Comparative analysis of total corneal HOA did not reveal a statistically significant difference in the main parameters: RMS coma, RMS SA, RMS HOA in patients after DSAEK and DMEK surgeries. Correlation analysis did not reveal any statistically significant effects of most aberrations on the functional outcomes of the treatment.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, Moscow, Russia
| | - G V Voronin
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - T R Sukhanov
- Lomonosov Moscow State University, Moscow, Russia
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36
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Lanza M, Boccia R, Ruggiero A, Melillo P, Bifani Sconocchia M, Simonelli F, Sbordone S. Evaluation of Donor and Recipient Characteristics Involved in Descemet Stripping Automated Endothelial Keratoplasty Outcomes. Front Med (Lausanne) 2021; 8:605160. [PMID: 33912573 PMCID: PMC8072002 DOI: 10.3389/fmed.2021.605160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
Aims: To evaluate both donor and recipient features involved in visual acuity restoring and complication insurgence in eyes that have undergone Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: In this retrospective study, charts of 111 eyes of 96 patients (mean age 70.25 ± 8.58 years) that underwent DSAEK were evaluated. Only Fuch's Distrophy (FD) or Bullous Keratopathy (BK) due to cataract surgery eyes were included. A complete ophthalmic check with endothelial cell density (ECD) and central corneal thickness (CCT) measurement was performed before surgery and at 1, 3, 6, and 12 months follow-up. Each DSAEK was performed by the same well-trained surgeon; only pre-cut lenticules, provided by same Eye Bank, were implanted. Results: A total of 48 (43%) complications have been observed (most of them were 22 partial graft detachments and 17 IOP spikes). At the last follow-up (mean: 8.58 ± 4.09 months), a significant increase (p < 0.05) of best corrected visual acuity (BCVA) was detected. Overall mean BCVA of the eyes evaluated was 0.40 ± 0.43 LogMAR with BK eyes showing a significantly higher improvement (p < 0.05) compared to FD eyes. The only factor showing a significant correlation (p < 0.05) with visual acuity enhancement was the implant of a lenticule thinner than 100 μm. Recipient features significantly (p < 0.05) associated with complications observed after surgery were glaucoma and diabetes mellitus. Conclusion: The use of a graft thinner than 100 μm can provide better visual acuity recovery while recipients affected by glaucoma or diabetes mellitus are more prone to develop complications after surgery.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Bifani Sconocchia
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical, and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Schiano-Lomoriello D, Abicca I, Bono V, Giannini D, Colabelli-Gisoldi RA, Boni N, Komaiha C, Pocobelli A. To compare corneal confocal microscopy of eyes with Fuchs' endothelial corneal dystrophy after two different endothelial surgeries. Eur J Ophthalmol 2021; 32:11206721211009451. [PMID: 33843319 DOI: 10.1177/11206721211009451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the features of corneal confocal microscopy of eyes with Fuchs' endothelial corneal dystrophy (FECD) after successful Descemet stripping automated endothelial keratoplasty (DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK). METHODS Thirty-two eyes affected by FECD with corneal oedema requiring a corneal graft were treated with DSAEK (15 eyes) or DMEK (17 eyes). All patients underwent in vivo corneal confocal microscopy (IVCCM) at 6 months postoperatively. We evaluated preoperative and postoperative corrected distance visual acuity (CDVA) and the correlation with IVCCM characteristics. RESULTS Using IVCCM, Z-scan curve analysis showed similar subepithelial reflectivity peaks between the two groups (DSAEK 1256 SU ± 514 vs DMEK 1118 SU ± 408, p = 0.411), while the interface reflectivity was significantly higher in the DMEK group (1511 SU ± 357) than in the DSAEK group (1029 SU ± 413, p = 0.002). CONCLUSION Comparing the corneal confocal microscopic characteristics after DMEK with those after DSAEK and their correlation with visual outcome at 6 months, we hypothesized that the presence of a third reflectivity peak in the Z-scan curves of DSAEK patients could justify the poorer visual outcome with this endothelial surgery than with DMEK.
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Affiliation(s)
| | | | | | | | | | - Nicoletta Boni
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Lazio, Italy
| | - Chiara Komaiha
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Lazio, Italy
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Mimouni M, Sorkin N, Slomovic J, Kisilevsky E, Mednick Z, Cohen E, Trinh T, Santaella G, Chan CC, Rootman DS, Slomovic AR. Descemet Membrane Endothelial Keratoplasty versus Descemet Stripping Automated Endothelial Keratoplasty in Complicated Vitrectomized Eyes. Curr Eye Res 2021; 46:1283-1290. [PMID: 33657945 DOI: 10.1080/02713683.2021.1892150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Vitrectomized eyes pose a technical challenge when performing endothelial keratoplasty (EK). The aim of the study was to compare outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in complex eyes undergoing pars plana vitrectomy (PPV) prior to or during surgery. METHODS This retrospective study included consecutive eyes that underwent pars plana infusion-assisted DMEK or pull-through DSAEK which underwent PPV prior to or during the EK at a tertiary center. Included were eyes with at least 1-year follow-up. The main outcome measures were best-corrected visual acuity (BCVA) and serious adverse events. RESULTS Fifty-two eyes (n = 52) with a mean follow-up time of 24.6 ± 7.4 months were included. Both groups were similar in terms of baseline characteristics although the DMEK group had a significantly larger proportion of Fuchs' patients (p = .009). There was no significant difference in postoperative logMAR BCVA between groups at each visit (p > .05 for all). There was a significantly higher proportion of overall serious adverse events (50.0% versus 15.4%, p = .02), retinal detachments (19.2% versus 0.0%, p = .05) and cystoid macular edema (23.1% versus 0.0%, p = .02) following DMEK. Graft detachment occurred more often following DMEK (53.9% versus 11.5%, p = .001) with no significant difference in rebubbling rates (23.1% versus 11.5%, p = .27). CONCLUSIONS A significant and similar improvement in BCVA was achieved following DMEK and DSAEK in complex vitrectomized eyes. Patients should be advised regarding the higher rates of potential serious complications associated with a pars plana infusion DMEK in this situation.
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Affiliation(s)
- Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.,Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacqueline Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Eli Kisilevsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Zale Mednick
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Gisella Santaella
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Tarnawska D, Balin K, Jastrzębska M, Talik A, Wrzalik R. Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet's Stripping Endothelial Keratoplasty. Materials (Basel) 2020; 13:ma13184145. [PMID: 32957729 PMCID: PMC7560278 DOI: 10.3390/ma13184145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
An intraocular lens (IOL) is a synthetic, artificial lens placed inside the eye that replaces a natural lens that is surgically removed, usually as part of cataract surgery. The opacification of the artificial lens can be related to the formation of the sediments on its surface and could seriously impair vision. The physicochemical analysis was performed on an explanted hydrophilic IOL and compared to the unused one, considered as a reference IOL. The studies were carried out using surface sensitive techniques, which can contribute to a better understanding of the sedimentation process on hydrophilic IOLs’ surfaces. The microscopic studies allowed us to determine the morphology of sediments observed on explanted IOL. The photoelectron spectroscopy measurements revealed the presence of organic and inorganic compounds at the lens surface. Mass spectroscopy measurements confirmed the chemical composition of deposits and allowed for chemical imaging of the IOL surface. Applied techniques allowed to obtain a new set of information approximating the origin of the sediments’ formation on the surface of the hydrophilic IOLs after Descemet’s stripping endothelial keratoplasty.
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Affiliation(s)
- Dorota Tarnawska
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, District Railway Hospital, Panewnicka 65, 40-760 Katowice, Poland
| | - Katarzyna Balin
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
- Correspondence:
| | - Maria Jastrzębska
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Agnieszka Talik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
| | - Roman Wrzalik
- August Chełkowski Institute of Physics, Faculty of Science and Technology, University of Silesia, 41-500 Chorzów, Poland; (M.J.); (A.T.); (R.W.)
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Hipólito-Fernandes D, Elisa-Luís M, Vieira M, Crisóstomo S, Alves N, Maduro V, Feijão J. Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses. Eur J Ophthalmol 2020; 31:1688-1694. [PMID: 32783469 DOI: 10.1177/1120672120950936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL). METHODS Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications. RESULTS Patients' mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up (p < 0.001), remaining stable over the entire follow-up period (p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm2. During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months). CONCLUSION Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.
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Affiliation(s)
- Diogo Hipólito-Fernandes
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - Maria Elisa-Luís
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - Miguel Vieira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - Sara Crisóstomo
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - Nuno Alves
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - Vitor Maduro
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
| | - João Feijão
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon, Portugal
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Alkhalifah M, Alqahtani B, Almulhim A, Alsarhani W. An endothelial rejection line following Descemet stripping automated endothelial keratoplasty. BMC Ophthalmol 2020; 20:307. [PMID: 32727405 PMCID: PMC7392701 DOI: 10.1186/s12886-020-01575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background The endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs). Here, we present a case of endothelial graft rejection with an endothelial rejection line occurring 1 year after the procedure. Case presentation A 58-year-old female presented with graft rejection 1 year following a DSAEK procedure. The episode started when she tapered down her loteprednol to once a day. Slit-lamp examination showed a mildly injected conjunctiva with 1+ corneal oedema. On the posterior surface of the cornea, there was an endothelial rejection line (Khodadoust line) with keratic precipitates and multiple areas of anterior synechia. Conclusion The classic endothelial rejection line should be kept in mind as a rare sign of DSAEK graft rejection.
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Affiliation(s)
- Muhannad Alkhalifah
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bader Alqahtani
- Department of Ophthalmology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Waleed Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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García Caride S, Cuiña Sardiña R, Perucho González L. Combined cataract surgery and lamellar endothelial keratoplasty in iridocorneal endothelial syndrome. ACTA ACUST UNITED AC 2020; 95:451-454. [PMID: 32595005 DOI: 10.1016/j.oftal.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
The case is reported of a 59-year-old woman, who reported decreased visual acuity (VA) in the left eye (LE). On examination, a corrected VA of finger count/ 30cm was observed in LE. Corneal oedema and folds in the Descemet's membrane were observed using the slit lamp. Anterior synechiae, iris atrophy, and corectopia were also found. Iridocorneal endothelial syndrome (ICE) was diagnosed. The treatment option was a combination of cataract surgery and automated endothelial keratoplasty with Descemet's membrane dissection (DSAEK). There were no complications during the operation, with a successful anatomical and functional recovery, with a VA of 0,8 being observed after one year. This result supports the efficacy of DSAEK in ICE syndrome, encouraging more studies to be carried out that should also support its efficacy in this syndrome.
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Affiliation(s)
- S García Caride
- Departamento de Oftalmología, Hospital Clínico San Carlos, Madrid, España.
| | - R Cuiña Sardiña
- Departamento de Oftalmología, Hospital Clínico San Carlos, Madrid, España
| | - L Perucho González
- Departamento de Oftalmología, Hospital Clínico San Carlos, Madrid, España
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43
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Mencucci R, Favuzza E, Marziali E, Cennamo M, Mazzotta C, Lucenteforte E, Virgili G, Rizzo S. Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison. Eye Vis (Lond) 2020; 7:25. [PMID: 32391399 PMCID: PMC7201595 DOI: 10.1186/s40662-020-00191-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/14/2020] [Indexed: 11/23/2022]
Abstract
Background To compare the visual outcome and patients’ satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) performed on fellow eyes of the same patients. Methods In this retrospective study, the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed. Best corrected visual acuity (BCVA), corneal pachymetry, keratometry, corneal aberrations, photopic and mesopic contrast sensitivity, and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared. The results of a satisfaction questionnaire were also reviewed. Results Twelve months after surgery, BCVA was not significantly different in UT-DSAEK and DMEK eyes (0.10 ± 0.04 and 0.07 ± 0.07 logMAR, respectively); at both 4- and 6 mm optical zones total and posterior corneal higher order aberrations (HOAs), posterior astigmatism and total coma were significantly lower after DMEK; BCVA in both groups was significantly correlated mainly with anterior corneal aberrations; contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies; the endothelial cell density was similar, although slightly higher in the UT-DSAEK group (p = 0.10). The satisfaction questionnaire showed that although patients were highly satisfied from both procedures, more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery. Conclusions DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA, although DMEK had a better performance in terms of contrast sensitivity, posterior corneal aberrations and overall patient satisfaction.
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Affiliation(s)
- Rita Mencucci
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
| | - Eleonora Favuzza
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
| | - Elisa Marziali
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
| | - Michela Cennamo
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
| | - Cosimo Mazzotta
- 2Department of Medicine, Surgery and Neurosciences, Ophthalmology Unit, Siena University, Siena, Italy.,Siena Crosslinking Center, Siena, Italy
| | - Ersilia Lucenteforte
- 4Department of Clinical and Experimental medicine, University of Pisa, Pisa, Italy
| | - Gianni Virgili
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
| | - Stanislao Rizzo
- 1Eye Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Eye Clinic, Largo Brambilla 3, 50134 Florence, Italy
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Cardascia N, Pastore V, Bini V, Lategola MG, Alessio G. Graft Detachment After Descemet's Stripping Automated Endothelial Keratoplasty in Bullous Keratopathy and Fuchs Dystrophy. Med Hypothesis Discov Innov Ophthalmol 2020; 9:15-22. [PMID: 31976339 PMCID: PMC6969561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Descemet's stripping automated endothelial keratoplasty (DSAEK) is a surgical technique for corneal transplantation in case of corneal decompensation. One of the main complications is graft detachment (GD) recoverable with Air Re-bubbling (ARB). The aim of this retrospective, interventional case series was to identify factors related to this complication in eyes operated for bullous keratopathy (BK) and Fuchs dystrophy (FD). We considered one-hundred patients who underwent DSAEK for BK or FD between January 2016 and October 2017 at Department of Ophthalmology, Policlinico Universitario of Bari, Italy. Studied parameters included physiological and pathological anamnesis of both donors and recipients and properties of donor's lenticules and of the recipient's corneas. Data was analyzed using One-way ANOVA with Tukey post hoc test and Chi-square test with Odds Ratio (OR) calculation. We grouped patients according to diagnosis. GD occurred in 9 eyes affected by BK and 19 by FD (p=0.003, OR = 0.25, 95% CI, 0.098-0.62). It was recovered with ARB. In BK, ARB correlated to complicated cataract extraction (p=0.04, OR = 7.83, 95% CI, 1.28 - 47.98) and aphakia (p=0.026, OR = 54.38, 95% CI, 2.51 - 11.76). In FD, ARB was associated to donor's death for neoplasia (p=0.06, OR= 4.04, 95% CI, 1.06 - 15.37). No other differences were found. In conclusion, we could hypothesize that in FD patients, donor's cancer therapy may play a role on altered corneal fibroblast metabolism, activating a synergetic effect between chemotherapy and genetic alteration of FD, which may lead to an altered adhesion of donor's lenticule on recipient's stroma. In BK patients, complicated cataract extraction and aphakic status of recipients' eye may contribute to altered adhesion of donor's lenticule post-DSAEK.
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Affiliation(s)
- Nicola Cardascia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari “A. Moro”,Bari, Italy
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari “A. Moro”,Bari, Italy
| | - Vito Bini
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari “A. Moro”,Bari, Italy
| | - Maria Gabriella Lategola
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari “A. Moro”,Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari “A. Moro”,Bari, Italy
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Abstract
PURPOSE To evaluate light scattering ability of the cornea before and after Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) endothelial keratoplasty. MATERIAL AND METHODS The study included 70 patients (70 eyes) who had undergone DSAEK and DMEK (35 patients, 35 eyes in each group). In addition to standard ophthalmological examinations before and during the one-year follow-up after surgery, the patients had their central corneal thickness, stromal thickness, thickness of the interface area and the graft measured with optical coherence tomography (Optovue, U.S.A.). Intensity of light scattering by corneal structures was evaluated using Pentacam HR (Oculus, Germany) topographer with proprietary software and algorithms for calculation of corneal transparency. RESULTS Comparison of the outcomes revealed that indices of general integral and stromal light-scattering were higher in patients after DSAEK. Integral light scattering in the interface and graft areas in the DMEK group was significantly lower than in the DSAEK group during the whole follow-up period. CONCLUSION The reason for decrease of visual acuity after endothelial keratoplasty, regardless of the surgery type, may be higher light-scattering ability of patient's corneal stroma due to residual opacifications. Better visual acuity outcomes after DMEK in comparison to DSAEK are associated with higher transparency of the interface and graft areas. The suggested new method of assessing the intensity of light-scattering allows more precise evaluation of the influence of light-scattering ability of the stroma, interface and corneal graft after different modifications of endothelial keratoplasty, considering the respective layer thickness and excluding the influence of light scattering on the air-epithelium interface.
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Affiliation(s)
| | - S V Trufanov
- Research Institute of Eye Diseases, Moscow, Russia
| | - I A Novikov
- Research Institute of Eye Diseases, Moscow, Russia
- Center of Information Technologies in Engineering, Russian Academy of Sciences, Odintsovo, Russia
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Tourabaly M, Chetrit Y, Provost J, Georgeon C, Kallel S, Temstet C, Bouheraoua N, Borderie V. Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty. Br J Ophthalmol 2019; 104:1317-1323. [PMID: 31848210 DOI: 10.1136/bjophthalmol-2019-315180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 11/04/2022]
Abstract
AIM To assess the influence of graft thickness and regularity on visual recovery and postoperative wavefront aberrations after endothelial keratoplasty (EK). METHODS 150 EKs performed in eyes with corneal endothelial disorders and no other ocular comorbidities, preoperative and postoperative assessment with spectral domain optical coherence tomography and postoperative assessment with whole eye wavefront aberrometry were retrospectively analysed. Eyes were classified into five groups: Descemet Membrane Endothelial Keratoplasty (DMEK), nanothin Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) (15-49 µm), ultrathin DSAEK (50-99 µm), thin DSAEK (100-149 µm) and conventional DSAEK (150-250 µm). RESULTS The preoperative diagnosis was Fuchs dystrophy in 139 eyes (92.7%). The graft thickness measured after graft deswelling was in average 74 µm with a mean coefficient of variation of 17%. The average follow-up time was 32 months. The mean spectacle-corrected logarithm of minimum angle of resolution visual acuity improved from 0.76 (20/116) before surgery to 0.14 (20/27) at last follow-up visit. No significant differences in final visual acuity were found between the five groups. The time to reach 20/40 vision was significantly shorter in the DMEK and nanothin DSAEK groups compared with the remaining three DSAEK groups. No significant differences in postoperative aberrometry measurements were found between the five groups. Shorter time to reach 20/40 visual acuity was associated with better preoperative visual acuity and thinner graft. Higher final vision improvement was associated with poorer preoperative visual acuity. Higher postoperative high-order aberrations were associated with poorer preoperative visual acuity. CONCLUSION The main advantage of DMEK and nanothin DSAEK over thicker DSAEKs was the rapidity of visual recovery. Final quality of vision was not influenced by graft thickness and regularity.
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Affiliation(s)
- Moïse Tourabaly
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Yaïr Chetrit
- Department of Ophthalmology, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Julien Provost
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Cristina Georgeon
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Sofiène Kallel
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Cyril Temstet
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Nacim Bouheraoua
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
| | - Vincent Borderie
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, Île-de-France, France
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47
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Hsiao FC, Chen PY, Meir YJ, Tan HY, Hsiao CH, Lin HC, Ma DH, Yeh LK, Wu WC, Chen HC. Clinical Outcomes of Penetrating Keratoplasty and Descemet Stripping Automated Endothelial Keratoplasty in Asian Population with American Corneas. Int J Environ Res Public Health 2019; 16:E4547. [PMID: 31744259 DOI: 10.3390/ijerph16224547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/26/2022]
Abstract
To determine the comparative efficacy and safety of penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in the Asian population receiving imported donor corneas, our single-center retrospective study provides analysis supporting the transition from PK to DSAEK in the Asian population using imported American donor corneas. We analyzed 259 patients with 241 and 57 cases of PK and DSAEK respectively during 2008 to 2017 using imported corneas at Chang Gung Memorial Hospital, Linkou, Taiwan. In terms of long-term graft survival analysis, there was no difference between PK and DSAEK (log-rank p = 0.386, HR = 0.920, 95% CI: [0.641–1.380]). However, Cox proportional regression analysis revealed that corneal survival rate of DSAEK group in the first 100 days after transplantation was inferior than that of PK group (log-rank p < 0.001, HR = 2.733, 95% CI: [1.501–4.977])]. Despite the inferior survival rate, there were significantly less neovascularization and Descemet membrane folds in the DSAEK group. Importantly, the non-complication rate of DSAEK was much higher than that of PK with significant difference (PK, 25.7% vs. DSAEK 42.0%, p = 0.022). Collectively, DSAEK is suggested as an alternative surgical modality in Asian patients using imported American donor corneas because of less complication, and no difference in long-term corneal graft survival rates between PK and DSAEK.
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48
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Abstract
PURPOSE To evaluate changes in clinical refraction after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK), and assess their correlation to the thickness of the transplant. MATERIAL AND METHODS The main study group included 40 patients (40 eyes) after DSAEK and 20 patients (20 eyes) after DMEK, the control group consisted of 20 patients (20 eyes) without any corneal pathologies or history of surgical treatment. In addition to standard examination, patients of the main group had central corneal thickness and transplant thickness regularly measured; they were also monitored by optical coherence tomography (Optovue, U.S.A.), computed tomography and aberrometry of the cornea performed on Pentacam device. The control group had the same examination regimen. RESULTS Best corrected visual acuity after 6 months was on average 0.2 higher in DMEK patients compared to those who underwent DSAEK; after one year - 0.1 higher. Clinical refraction data shows presence of hypermetropic changes after DSAEK surgery. Induced astigmatism after one year was 0.4 Diopters in DSAEK patients, but did not exceed 0.1 Diopters in DMEK patients. Stabilization of the corneal thickness in DMEK group occurred on the 3-4th month, in DSAEK group - 6-7th month. Certain values of higher-order aberrations (3-6) and root-mean-square deviation (RMS) of the wave-front of anterior corneal surface in DSAEK and DMEK groups were higher than in the control group. Aberrations on the posterior corneal surface in DMEK group were significantly lower than in DSAEK group. There were no statistically significant differences in 'final' RMS higher-order aberrations between DMEK and DSAEK groups.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E P Salovarova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E V Sukhanova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - T R Sukhanov
- Lomonosov Moscow State University, Faculty of Physics, 1-2 Leninskie Gory St., Moscow, Russian Federation, 119991
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49
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Li KY, Pan HA, Chen KH, Kuo TL, Chou CH, Liang YJ, Lin FH. Fish-Scale Collagen Membrane Seeded with Corneal Endothelial Cells as Alternative Graft for Endothelial Keratoplasty Transplantation. ACS Biomater Sci Eng 2019; 6:2570-2577. [PMID: 33463278 DOI: 10.1021/acsbiomaterials.9b00562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The human corneal endothelium has limited regeneration capacity. Several methods have been developed in an attempt to repair it. Descemet stripping automated endothelial keratoplasty (DSAEK) is commonly performed on patients with endothelial dysfunction. However, donor demand far exceeds donor supply. Here, we prepared fish-scale collagen membrane (FSCM) and seeded it with CECs in preparation for corneal endothelial transplantation. The fish scales were decellularized, decalcified, and curved. The FSCM was inspected by fluorescence microscopy, SEM, and TGA to validate decellularization, microstructure, and decalcification, respectively. The cytotoxicity of FSCM and the viability of the cells in contact with it were evaluated by LDH and WST-1, respectively. CEC tight junctions and ZO-1 structure were observed by SEM and confocal microscopy. FSCM seeded with CECs were implanted to rabbit anterior chambers to evaluate host tissue reactions to it. FSCM biocompatibility and durability were also assessed. The results showed that FSCM has excellent transparency, adequate water content, and good biocompatibility. The cultivated CECs mounted on the FSCM were similar to normal CECs in vivo. The FSCM plus CECs developed here have high potential efficacy for endothelial keratoplasty transplantation.
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Affiliation(s)
- Keng-Yuan Li
- Department of Biomedical Engineering, National Taiwan University, Taipei 10051, Taiwan
| | - Hsu-An Pan
- Department of Research, Body Organ Biomedical Corp, Taipei 11493, Taiwan
| | - Ko-Hua Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tzu-Lin Kuo
- Department of Biomedical Engineering, National Taiwan University, Taipei 10051, Taiwan
| | - Cheng-Hung Chou
- Department of Research, Body Organ Biomedical Corp, Taipei 11493, Taiwan
| | - Ya-Jyun Liang
- Department of Biomedical Engineering, National Taiwan University, Taipei 10051, Taiwan
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 10051, Taiwan.,Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County 35053, Taiwan
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50
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Al-Romaih AZ, Al-Jindan MY, Al-Johani SM. Glued Intraocular Lens Combined with Endothelial Keratoplasty: A Case Report. Saudi J Med Med Sci 2019; 7:179-182. [PMID: 31543740 PMCID: PMC6734731 DOI: 10.4103/sjmms.sjmms_19_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 10/23/2018] [Accepted: 06/27/2019] [Indexed: 11/04/2022]
Abstract
In an aphakic eye with corneal edema, performing Descemet's stripping automated endothelial keratoplasty (DSAEK) combined with implantation of intraocular lens can be a challenge. This case report describes a surgical technique for postsurgical aphakia with endothelial decompensation in a 42-year-old female with Marfan syndrome and subluxated lens. This technique comprised implanting DSAEK with fibrin glue-assisted sutureless posterior chamber intraocular lens. The donor lenticels were formed on a 60-kHz femtosecond laser platform (IntraLase®). Two partial-thickness scleral flaps and sclerotomies were created, and then, the Descemet's membrane was scored and stripped. A posterior chamber intraocular lens was implanted, and its haptics was pulled out through the sclerotomies and tucked beneath the flaps. The flaps were then apposed with fibrin glue. The donor lenticule was introduced to the anterior chamber and unfolded. Air tamponade was used to stabilize and center it. This technique significantly improved the uncorrected and best-corrected visual acuities of the patient, and no donor dislocations were reported. This case corroborates the findings of few similar cases that have found combined use of glued intraocular lens with DSAEK to be beneficial in such cases.
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Affiliation(s)
- Arwa Z Al-Romaih
- Department of Ophthalmology, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Mohanna Y Al-Jindan
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saud M Al-Johani
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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