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Berger T, Schlötzer-Schrehardt U, Flockerzi F, Daas L, Flockerzi E, Seitz B. Severe ulcerative keratopathy following implantation of an acellular porcine corneal stromal lenticule in a patient with keratoconus. Cont Lens Anterior Eye 2024; 47:102145. [PMID: 38472013 DOI: 10.1016/j.clae.2024.102145] [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: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To report a case of ulcerative keratopathy following implantation of acellular porcine corneal stroma (APCS) in a patient with keratoconus (KC). METHODS A 58 year-old patient initially presented with an ulcerative keratopathy in the left eye. Previously, several corneal procedures (including radial keratotomy, laser-in-situ keratomileusis, crosslinking) were performed for KC. Eight months ago, an APCS lenticule (Xenia corneal implant, Gebauer Medizintechnik GmbH, Neuhausen, Germany) was implanted into a stromal pocket because of progressive keratectasia. Visual acuity was hand movement. Anterior segment optical coherence tomography showed a space between the APCS lenticule and the host stroma. Excimer laser-assisted penetrating keratoplasty (PKP, 8.0/8.1 mm) was performed in the left eye. The corneal explant was investigated by light and transmission electron microscopy. RESULTS Best-corrected visual acuity was 20/40 six weeks after PKP. Light microscopy demonstrated a stromal ulceration down to the APCS lenticule. No stromal cells could be found within the APCS lenticule eight months after implantation. The APCS lenticule did not show a green stain of the collagens with Masson-Goldner staining and exhibited a strong Periodic acid-Schiff positive reaction. Electron microscopy of the APCS lenticule revealed cross-linked collagen lamellae without cellular components. Close to the interface, corneal collagen lamellae of the host cornea were disorganized. Few vital keratocytes were present on the surface of the lenticule and appeared to cause mechanical disruption of the host stroma along the lenticule-stroma interface. CONCLUSION APCS implantation may lead to severe complications such as ulcerative keratopathy in otherwise uncomplicated KC corneas. In such cases, excimer laser-assisted PKP or Deep Anterior Lamellar Keratoplasty are the methods of choice to restore visual acuity.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany.
| | | | - Fidelis Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
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Akepogu J, Jakati S, Chaurasia S, Ramachandran C. Evidence for persistent UV-induced DNA damage and altered DNA damage response in xeroderma pigmentosa patient corneas. Exp Eye Res 2024; 243:109901. [PMID: 38641197 DOI: 10.1016/j.exer.2024.109901] [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: 10/04/2023] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Xeroderma pigmentosum (XP) is a rare genetic disorder characterized by injury to the ocular surface due to exposure to ultraviolet (UV) radiation. UV-induced damage in the cells leads to the formation of cyclobutane pyrimidine dimers (CPDs) and 6-4 pyrimidine-pyrimidone photoproducts that are repaired by the NER (Nucleotide Excision Repair) pathway. Mutations in the genes coding for NER proteins, as reported in XP patients, would lead to sub-optimal damage repair resulting in clinical signs varying from photo-keratitis to cancerous lesions on the ocular surface. Here, we aimed to provide evidence for the accumulation of DNA damage and activation of DNA repair pathway proteins in the corneal cells of patients with XP. Corneal buttons of patients who underwent penetrating keratoplasty were stained to quantify DNA damage and the presence of activated DNA damage response proteins (DDR) using specific antibodies. Positive staining for pH2A.X and thymidine dimers confirmed the presence of DNA damage in the corneal cells. Positive cells were found in both control corneas and XP samples however, unlike normal tissues, positive cells were found in all cell layers of XP samples indicating that these cells were sensitive to very low levels of UV. pH2A.X-positive cells were significantly more in XP corneas (p < 0.05) indicating the presence of double strand breaks in these tissues. A positive expression of phosphorylated-forms of DDR proteins was noted in XP corneas (unlike controls) such as ataxia telangiectasia mutated/Rad-3 related proteins (ATM/ATR), breast cancer-1 and checkpoint kinases-1 and -2. Nuclear localization of XPA was noted in XP samples which co-localized (calculated using Pearson's correlation) with pATM (0.9 ± 0.007) and pATR (0.6 ± 0.053). The increased presence of these in the nucleus confirms that unresolved DNA damage was accumulating in these cells thereby leading to prolonged activation of the damage response proteins. An increase in pp53 and TUNEL positive cells in the XP corneas indicated cell death likely driven by the p53 pathway. For comparison, cultured normal corneal epithelial cells were exposed to UV-radiation and stained for DDR proteins at 3, 6 and 24 h after irradiation to quantify the time taken by cells with intact DDR pathway to repair damage. These cells, when exposed to UV showed nuclear translocation of DDR proteins at 3 and 6 h which reduced significantly by 24 h confirming that the damaged DNA was being actively repaired leading to cell survival. The persistent presence of the DDR proteins in XP corneas indicates that damage is being actively recognized and DNA replication is stalled, thereby causing accumulation of damaged DNA leading to cell death, which would explain the cancer incidence and cell loss reported in these patients.
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Affiliation(s)
- Jacquelyn Akepogu
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India; Manipal Academy of Higher Education, Manipal, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Charanya Ramachandran
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.
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Kitazawa K, Toda M, Ueno M, Wakimasu K, Tomioka Y, Uehara A, Sotozono C, Kinoshita S. Donor Corneal Endothelial Cell Maturity and Its Impact on Graft Survival in Glaucoma Patients Undergoing Corneal Transplantation. Am J Ophthalmol 2024; 262:1-9. [PMID: 38307212 DOI: 10.1016/j.ajo.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To examine corneal graft survival via corneal endothelial cell density (ECD) and corneal endothelial cell loss (ECL) at 5 years post-transplantation in the eyes of patients with and without a history of undergoing glaucoma surgery according to the maturity of the donor corneal endothelial cells. DESIGN Prospective cohort study. METHODS This prospective cohort study included 17 patients with glaucoma and 51 patients without glaucoma who underwent Descemet's stripping automated endothelial keratoplasty or penetrating keratoplasty at the Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. Human corneal endothelial cells were cultured from residual peripheral donor cornea tissue, and the maturity of the cells was evaluated by cell surface markers (ie, CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Kaplan-Meier analysis or the chi-square test was used to assess the rate of successful corneal graft survival post-transplantation. RESULTS At 36 months postoperatively, the mean ECD and ECL in the glaucoma-bleb eyes were 1197 ± 352 cells/mm2 and 55.5% ± 13.9% in the high-maturity group and 853 ± 430 cells/mm2 and 67.7% ± 18.1% in the low-maturity group, respectively. Kaplan-Meier analysis revealed that at 5 years postoperatively, the overall rate of survival was 45%, that is, 100% in the high-maturity group and 25% in the low-maturity group (P < .05). CONCLUSIONS The findings in this prospective cohort study revealed that the use of donor corneal grafts containing mature-differentiated corneal endothelial cells could maintain the survival of the transplanted graft for a long-term period, even in patients with a history of undergoing glaucoma surgery.
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Affiliation(s)
- Koji Kitazawa
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Munetoyo Toda
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (M.T., S.K.)
| | - Morio Ueno
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Koichi Wakimasu
- Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Yasufumi Tomioka
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Asako Uehara
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Chie Sotozono
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Shigeru Kinoshita
- Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.); Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (M.T., S.K.).
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Iselin KC, Hjortdal J, Armitage WJ, Tole D, Pleyer U, Vabres B, Griffin MD, Murphy CC. Outcomes after reversed corneal graft rejection: a report from the European VISICORT project. BMJ Open Ophthalmol 2024; 9:e001554. [PMID: 38772878 DOI: 10.1136/bmjophth-2023-001554] [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: 11/28/2023] [Accepted: 04/27/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE This study aims to describe the outcome of corneal grafts, both low risk and high risk, after successfully reversed immunological rejection. METHODS Datasets on reversed rejection episodes in penetrating and endothelial keratoplasties between 2014 and 2019 (n=876) were extracted from the Adverse Immune Signatures and their Prevention in Corneal Transplantation database, which contains the prospectively and consecutively collected corneal transplants from five European centres. Stratified by the preoperatively determined risk status for immunological rejection, the outcome parameters analysed included visual acuity, intraocular pressure, endothelial cell density and central corneal thickness before and after reversed rejection episodes. RESULTS Fourty-seven (52%) out of a total of 91 identified rejection episodes were successfully reversed and were available for analysis (23 penetrating and 24 endothelial keratoplasties). No statistically significant change was found for any of the parameters studied between the values before and the values 3 months after the rejection episode, irrespective of the preoperative risk status. CONCLUSION The outcome of corneal grafts that survive immunological rejection may be clinically indistinguishable from the state before immunological rejection, irrespective of graft type and risk status. These findings support clinicians by providing information on prognosis after reversed rejection episodes and by giving patients realistic expectations regarding the outcome.
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Affiliation(s)
- Katja C Iselin
- Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - W John Armitage
- Department of Ophthalmology, Bristol University, Bristol, UK
| | - Derek Tole
- Department of Ophthalmology, Bristol University, Bristol, UK
| | - Uwe Pleyer
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bertrand Vabres
- Department of Ophthalmology, Centre hospitalier universitaire de Nantes, Nantes, France
| | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI), CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Conor C Murphy
- Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Malepati N, Mitra S, Chandran K, Shanbhag SS. Secondary bacterial corneal infection caused by Myroides species in primary fungal keratitis. BMJ Case Rep 2024; 17:e258474. [PMID: 38719269 PMCID: PMC11085784 DOI: 10.1136/bcr-2023-258474] [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: 05/13/2024] Open
Abstract
A middle-aged male patient presented with a central corneal perforation in a deep stromal infiltrate in his left eye. An emergency therapeutic penetrating keratoplasty was performed. Microbiological evaluation of the corneal scraping specimen revealed septate fungal filaments on stains. However, culture reports after 24 hours from the scraping sample and the excised half corneal button showed growth of gram-negative bacilli. This pathogen was identified as an aerobic, non-fermentative, gram-negative, bacillus by conventional microbiology and confirmed as Myroides species by the VITEK 2 Compact system (bioMérieux, Marcy l'Etoile, France). Susceptibility to chloramphenicol was noted based on which the patient was treated with topical chloramphenicol 0.5%. No recurrence of the infection was noted. This is the first reported case of corneal infection with the Myroides species of bacteria which, heretofore, have been known to cause endocarditis and urinary tract infections.
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Affiliation(s)
- Nikhila Malepati
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sanchita Mitra
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kavya Chandran
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Diaz-Valle D, Burgos-Blasco B, Ariño-Gutierrez M, Gegundez-Fernandez JA. Predescemetic femtosecond laser-assisted deep anterior lamellar keratoplasty with simulated pachymetry. Graefes Arch Clin Exp Ophthalmol 2024; 262:1653-1655. [PMID: 38217768 DOI: 10.1007/s00417-024-06370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Affiliation(s)
- David Diaz-Valle
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Barbara Burgos-Blasco
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain.
| | - Mayte Ariño-Gutierrez
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Jose Antonio Gegundez-Fernandez
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Tara D, Vuyyuru S, Shetty PA, Bhalerao SA. Letter Regarding: Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar. Cornea 2024; 43:e9. [PMID: 38287472 DOI: 10.1097/ico.0000000000003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Divya Tara
- Shantilal Shanghvi Cornea Institute (SSCI), Kode Venkatadri Chowdary (KVC) Campus, L V Prasad Eye Institute (LVPEI), Vijayawada, Andhra Pradesh, India
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Li S, Zhang P, Li A, Bao J, Pan Z, Jie Y. Rho-kinase inhibitor alleviates CD4 +T cell mediated corneal graft rejection by modulating its STAT3 and STAT5 activation. Exp Eye Res 2024; 242:109857. [PMID: 38479724 DOI: 10.1016/j.exer.2024.109857] [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: 07/30/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Penetrating keratoplasty remains the most common treatment to restore vision for corneal diseases. Immune rejection after corneal transplantation is one of the major causes of graft failure. In recent years, Rho-associated protein kinase (ROCK) inhibitors have been found to be associated with the activation of the STATs pathway and are widely studied in autoimmune diseases. Therefore, it may be possible that the ROCK inhibitors also participate in the local and systemic immune regulation in corneal transplantation through activation of the STATs pathway and affect the CD4+ T cell differentiation. This study aimed to explore the role of ROCK-STATs pathway in the occurrence of immune rejection in corneal transplantation by applying Y27632, a ROCK inhibitor, to the recipient mice and peripheral CD4+ T cells. We found that Y27632 significantly up-regulated the phosphorylation level of STAT5 in both spleen and lymph nodes, down-regulated the phosphorylation level of STAT3 in the CD4+ T cells in the spleen. It also increased the proportion of CD4+CD25+Foxp3+Helios+ Tregs while decreased CD4+IL17A+ -Th17 cells. Moreover, Y27632 also reduced the proportion of dendritic cells in both spleen and lymph nodes, as well as the expression level of CD86 on their surfaces in the spleen, while the proportion of macrophages was not affected. The expression levels of ROCK1, ROCK2, CD11c and IL-17A mRNA were also found to be low in the graft tissue while the expression of Helios was upregulated. Rho-kinase inhibitor can modulate the balance of Tregs/Th17 by regulating the phosphorylation levels of both STAT3 and STAT5, thereby inhibiting the occurrence of immune rejection in allogeneic corneal transplantation.
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Affiliation(s)
- Shang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Peng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Jiayu Bao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Zhiqiang Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China.
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Lu SH, Qiao DN, Dong PF. A nursing report on a corneal contact lens wearer receiving keratoplasty due to corneal ulcer and perforation caused by Pythium insidiosum infection: A case report. Medicine (Baltimore) 2024; 103:e37663. [PMID: 38579080 PMCID: PMC10994501 DOI: 10.1097/md.0000000000037663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND To report the nursing experience of a case of corneal contact lens wearer receiving the 2nd keratoplasty due to corneal ulcer and perforation caused by Pythium insidiosum infection. METHODS A 30-year-old female patient had blurred vision after deep anterior lamellar keratoplasty for a right corneal ulcer. At the 5th week, the right eye appeared the symptoms, such as redness and pain. The anterior segment photography was performed on the eye, and the result showed that the epithelium was missing in the right eye lesion area, and a large number of longitudinal and transversal streaks were visible from the epithelium to the stroma, with fungus filaments to be discharged. Upon macro-genome sequencing of the corneal secretion, a P. insidiosum infection was observed. Then, the patient underwent the keratoplasty, and 3 weeks later, the corneal implant showed a tendency to dissolve, the sutures were partially loosened, and the eye was almost blind. Subsequently, the patient was admitted to our hospital and subject to the 2nd penetrating keratoplasty of the right eye (allograft). After surgery, linezolid and azithromycin injections were given through intravenous drip and local drip of the eye for anti-inflammation, and tacrolimus eye drops for antirejection. RESULTS Postoperatively, the patient showed signs of recovery with slight corneal edema and visible pupil, leading to discharge with improved vision. The corneal implant was normal 1 week after surgery and the vision of the right eye was hand move/before eye at the 6th month of follow-up. Continuous care and removal of sutures 3 months post-surgery contributed to a successful outcome, with the patient achieving hand motion vision 6 months after the procedure. CONCLUSION Corneal ulcer caused by P. insidiosum infection not only needs timely and effective keratoplasty intervention, but also requires perfect nursing measures.
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Affiliation(s)
- Shui-hua Lu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dan-ni Qiao
- Department of Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pei-fang Dong
- Department of Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Gómez-Calleja V, Burgos-Blasco B, Méndez-Fernández R, Pérez-García P, Ariño-Gutiérrez M, Borrego-Sanz L, Colino Gallardo AM, Díaz-Valle D. Congenital stromal corneal dystrophy in a Spanish family: Clinical, genetic and histological analysis. J Fr Ophtalmol 2024; 47:104138. [PMID: 38484481 DOI: 10.1016/j.jfo.2024.104138] [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: 06/01/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 04/08/2024]
Abstract
PURPOSE To present the clinical, genetic, and histopathological features of the ninth family affected by congenital stromal corneal dystrophy (CSCD) to date. METHODS Twelve cases of a Spanish family affected by CSCD were analyzed regarding history, visual acuity (VA, decimal scale), an ophthalmologic exam and specular microscopy. Five eyes were treated by deep anterior lamellar keratoplasty (DALK), and thirteen eyes by penetrating keratoplasty (PK). In the two last generations, a genetic study was performed. RESULTS Most of the patients affected were born with opaque corneas except for three, whose corneas were clear at birth. Biomicroscopy showed a whitish diffuse stromal opacity with an unaltered epithelium, causing poor VA (from hand motions to 0.4). Patients treated with PK presented mean postoperative VA of 0.19±0.20 over a follow-up time of 235.3±101.4months with 38% recurrences. Patients who underwent DALK experienced VA improvement to 0.17±0.11 over a follow-up time of 10.8±2.6months without signs of recurrence. In the latter, the big bubble technique was not achieved, so a manual technique was performed. The genetic study showed heterozygosis for a 1-bp deletion at nucleotide 962 in exon 8 of the decorin gene. CONCLUSIONS CSCD is a rare entity, which should be treated by DALK whenever possible, obtaining better results than PK. Close monitoring of children of affected individuals is important, because CSCD can progress during the early years of life.
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Affiliation(s)
- V Gómez-Calleja
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - R Méndez-Fernández
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - P Pérez-García
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - M Ariño-Gutiérrez
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Borrego-Sanz
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A M Colino Gallardo
- Anatomic Pathology Departament of Hospital Clínico San Carlos, Madrid, Spain
| | - D Díaz-Valle
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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11
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Yeh TC, Hsu CC, Lu YH, Chen YR, Niu DM, Lin PY. Novel Manifestation of Corneal Dystrophy After Keratorefractive Surgery. Cornea 2024; 43:404-408. [PMID: 37506370 DOI: 10.1097/ico.0000000000003355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE This study aimed to report cases of bilateral corneal Bowman layer deposits in 4 patients with a history of keratorefractive surgery. To our knowledge, this condition has not previously been reported and should be distinguished from granular corneal dystrophy type 2 and other corneal dystrophies. METHODS We reviewed all available medical records that were collected between January 2010 and December 2021 at a tertiary referral center and performed whole-exome sequencing to provide diagnostic information. RESULTS Four patients exhibited similar bilateral corneal deposits that were observed more than 10 years after keratorefractive surgery. The patients' ages ranged from 36 to 53 years; 3 of the 4 patients were female. Three patients received laser in situ keratomileusis surgery, and 1 received radial keratotomy. All 4 patients denied having a family history of ocular diseases and reported an uneventful postoperative course. On examination, the best-corrected visual acuity ranged from 6/10 to 6/6 in all 4 patients. Slit-lamp examination revealed bilateral superficial corneal deposits involving the central cornea, and anterior segment optical coherence tomography revealed hyperreflective deposits located in the Bowman layer. Such unique manifestations suggested corneal dystrophy; thus, whole-exome sequencing was performed on all 4 patients. Only 1 patient exhibited a missense mutation in TGFBI . We further analyzed common de novo mutations to explore possible candidate genes associated with this presentation. CONCLUSIONS We report a rare entity of presumed corneal dystrophy with deposits located in the Bowman layer in 4 patients who had received keratorefractive surgery. Clarifying the underlying pathophysiology and genetic predisposition of this disease may aid in diagnosing and preventing potential complications after keratorefractive surgery.
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Affiliation(s)
- Tsai-Chu Yeh
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Hsiu Lu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Yun-Ru Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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12
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Chaurasia S, Mishra DK, Murthy S, Das R, Edward DP, Ramappa M. Clinical and Optical Coherence Tomography Correlation of Recurrence Patterns After Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty in Reis-Bucklers Corneal Dystrophy. Cornea 2024; 43:459-465. [PMID: 37713662 DOI: 10.1097/ico.0000000000003387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE The aim of this study was to report the clinical profile and patterns of recurrence after femtosecond laser-assisted anterior lamellar keratoplasty (FALK) in Reis-Bucklers corneal dystrophy. METHODS This is a case series of 5 eyes of 4 patients with Reis-Bucklers corneal dystrophy. Clinical images of recurrence were correlated with the high-resolution optical coherence tomography. Histopathologic examination of excised corneal samples was performed when possible. RESULTS The median time to recurrence was 2 (1-5) years after FALK. Of the 5 eyes, 1 eye had primary FALK, whereas 4 eyes had secondary interventions, which included previous phototherapeutic keratectomy (once in 1 eye and twice in 2 eyes), and previous penetrating keratoplasty, followed by phototherapeutic keratectomy (1 eye). Recurrence was noted at the level of the subepithelium. In addition, 1 eye showed interface deposits along with epithelial downgrowth at the graft-host bed. CONCLUSIONS The 2 distinct patterns of recurrence noted were at the subepithelial region and the interface. The clinical patterns of recurrence favor an epithelial origin of recurrent deposits.
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Affiliation(s)
- Sunita Chaurasia
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Dilip K Mishra
- Ocular Pathology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Somasheila Murthy
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Rajashree Das
- Cornea Services, Bangladesh Eye Hospital, Dhaka, Bangladesh; and
| | - Deepak P Edward
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Muralidhar Ramappa
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
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13
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Qi X, Mao H, Liu J, Dong Y, Du M, Liu T, Zhang T, Lu X, Gao H. Comparison of therapeutic effects between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis. BMC Infect Dis 2024; 24:276. [PMID: 38438857 PMCID: PMC10910827 DOI: 10.1186/s12879-024-09147-w] [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: 07/31/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). METHODS This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. RESULTS The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. CONCLUSION Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
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Affiliation(s)
- Xiaolin Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Huilin Mao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Jinhui Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Yanling Dong
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Man Du
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Ting Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiuhai Lu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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14
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Kemer Atik B, Emul M, Kirgiz A, Cubuk MO, Ahmet S, Kandemir Besek N. Effect of Keratoconus Stage and Classification Parameters on Deep Anterior Lamellar Keratoplasty Outcomes. Cornea 2024; 43:327-332. [PMID: 37603697 DOI: 10.1097/ico.0000000000003362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/02/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of the keratoconus (KC) stage according to the Amsler-Krumeich classification system and the parameters used in this classification on deep anterior lamellar keratoplasty outcomes. METHODS The preoperative KC stage was determined, and the presence of corneal scarring was noted. The preoperative and postoperative best-corrected visual acuity (BCVA), refractive error, mean central keratometry (K mean ) readings, topographic astigmatism, and minimum corneal thickness (CT) values were recorded. Intraoperative and postoperative complications were also noted. RESULTS One hundred thirty-seven eyes (54 eyes in stage 3-83 eyes in stage 4) were included in the study. The mean follow-up period was 42.20 ± 24.36 months. There was no statistically significant difference between stage 3 and 4 KC groups for postoperative BCVA, K mean , CT, spherical equivalent, and topographic astigmatism values (each P value >0.05). The effect of preoperative BCVA, K mean , CT, and refractive error values on postoperative BCVA could not be demonstrated ( P = 0.264). In addition, no statistically significant correlation was found between postoperative and preoperative values (each P value > 0.05). Although intraoperative Descemet membrane perforation and postoperative early suture loosening were observed more frequently in stage 4 KC than in stage 3 KC, the 2 groups were statistically similar for these and other complications (each P value >0.05). CONCLUSIONS The preoperative KC stage and the parameters used in classification are not useful in predicting postoperative deep anterior lamellar keratoplasty outcomes. The timing of the surgery should be planned with the awareness that the progression of the disease will not have a negative effect on outcomes.
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Affiliation(s)
- Burcu Kemer Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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15
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Pollmann AS, Pinto AM, Cadieux D, Seamone CD, George SP, Smith CA, Lewis DR. Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency. Cornea 2024; 43:349-355. [PMID: 37433174 PMCID: PMC10836790 DOI: 10.1097/ico.0000000000003347] [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: 03/10/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada. METHODS A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time. RESULTS Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19-1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61-0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17-1.17; P = 0.13). CONCLUSIONS Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.
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Affiliation(s)
- André S. Pollmann
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Ashlyn M. Pinto
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Danielle Cadieux
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Christopher D. Seamone
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Stanley P. George
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Corey A. Smith
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Darrell R. Lewis
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
- Herzig Eye Institute and Precision Cornea Centre, Ottawa, ON, Canada
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16
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Berger T, Seitz B, Flockerzi E, Suffo S, Flockerzi FA, Berger M, Szentmáry N, Daas L. Surgical management of complicated Descemet's membrane detachment in corneas without prior endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2024; 262:879-889. [PMID: 37682334 PMCID: PMC10907463 DOI: 10.1007/s00417-023-06231-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention. METHODS Retrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD. RESULTS Fourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months - 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet's membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes. CONCLUSION PKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Fidelis A Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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17
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Wykrota AA, Hamon L, Daas L, Seitz B. Descemet Membrane Endothelial Keratoplasty after failed penetrating keratoplasty- case series and review of the literature. BMC Ophthalmol 2024; 24:15. [PMID: 38191393 PMCID: PMC10775423 DOI: 10.1186/s12886-023-03279-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND This study aims to evaluate visual outcome, central corneal thickness, and re-bubbling rate in a cohort with undersized sequential Descemet Membrane Endothelial Keratoplasty (DMEK) due to endothelial graft decompensation following primary penetrating keratoplasty (PK). METHODS All patients who received a sequential DMEK (n = 16) or triple DMEK (n = 2) after failed primary PK between November 2020 and June 2022 were retrospectively evaluated. Analyzed parameters were corrected distance visual acuity (CDVA), central corneal thickness (CCT), re-bubbling rate and graft survival. RESULTS 18 eyes of 18 patients were included. All patients underwent a DMEK with undersized graft after failed PK(s). Mean time between the last PK and DMEK was 102 ± 82 weeks. Mean follow-up time was 8.9 ± 4.6 months. CDVA increased significantly from 1.12 ± 0.60 logMAR preoperatively to 0.64 ± 0.49 logMAR 6 weeks postoperatively (p = 0.013). Mean CCT decreased significantly from 807 ± 224 μm before to 573 ± 151 μm 6 weeks after DMEK (p = 0.003). Re-bubbling was necessary in eight eyes (44.4%) after a median time of 7 days. The 12-month Kaplan Meier survival was 66.7%. CONCLUSION In case of endothelial graft decompensation without stromal scars after primary PK, a DMEK can be performed for selected patients who had satisfying CDVA before the endothelial decompensation. Prior to DMEK indication, an AS-OCT should routinely be performed to circularly search for posterior steps at the PK graft margin, as well as shortly after DMEK to exclude a detachment of the endothelial graft. All patients should be informed about a higher re-bubbling rate in comparison to primary DMEK.
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Affiliation(s)
- Agata Anna Wykrota
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany.
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
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Colombo-Barboza GN, Rodrigues PF, Colombo-Barboza FDP, Moscovici BK, Colombo-Barboza LR, Colombo-Barboza MN, Nose W. Radial keratotomy: background and how to manage these patients nowadays. BMC Ophthalmol 2024; 24:9. [PMID: 38178013 PMCID: PMC10768088 DOI: 10.1186/s12886-023-03261-0] [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: 07/26/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
In this review, we presented the principles of radial keratotomy (RK), its evolution, enhancement, and complications, and strategies to manage the consequences of RK in the present day. It is essential to understand the RK procedure f, the theoretical background that supported this surgery, the current effect on the cornea, and how to approach patients needing vision improvement. These patients are developing cataracts that need to be handled well, from the IOL calculation to the surgical procedure. Guided keratorefractive surgery is the most accurate procedure to improve these patient's vision and life. Nevertheless, some patients may need other approaches, such as sutures, penetrating keratoplasty, corneal rings, and pinhole implants, depending on the degree of irregularity of the cornea, ablation depth for guided surgery or if the sutures are open.
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Affiliation(s)
- Guilherme Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil.
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
- Department of Ophthalmology, Santos Medical Sciences (UNILUS), Santos, Brazil.
- Department of Ophthalmology, UNIMES Medicine College, Santos, Brazil.
| | - Pablo Felipe Rodrigues
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Bernardo Kaplan Moscovici
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Marcello Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, Santos Medical Sciences (UNILUS), Santos, Brazil
| | - Walton Nose
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Parmar G, Chatterjee S, Kapur N, Gomase SN, Khurana A, Borde P, Acharya M, Sangwan VS, Majumdar A. Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty. Indian J Ophthalmol 2024; 72:87-93. [PMID: 38131576 PMCID: PMC10841796 DOI: 10.4103/ijo.ijo_721_23] [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: 03/14/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To report the indications for keratoplasty and analyze trends in two decades in India. METHODS This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. RESULTS Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. CONCLUSION Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.
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Affiliation(s)
- Gautam Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Samrat Chatterjee
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Neha Kapur
- Department of Cornea and Anterior Segment, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Sharad N Gomase
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Ashi Khurana
- Department of Cornea and Anterior Segment, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Prashant Borde
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Acharya
- Department of Cornea and Anterior Segment, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Virendra S Sangwan
- Department of Cornea and Anterior Segment, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Department of Biostatistics, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
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Ruiz MGS, Pérez LA, Picazo CC, Sanz LS, Ontiveros AH, Gregori EE. Acute calcareous corneal degeneration in a patient with chronic graft-versus-host disease. Rom J Ophthalmol 2024; 68:53-56. [PMID: 38617729 PMCID: PMC11007567 DOI: 10.22336/rjo.2024.10] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 04/16/2024] Open
Abstract
Objective: To describe acute calcareous corneal degeneration as a complication of chronic graft-versus-host disease. Materials and methods: Clinical case and review of the literature. Results: We presented a case of bilateral acute calcareous corneal degeneration in a patient with chronic graft-versus-host disease. Conclusions: Chronic graft-versus-host disease (cGVHD) occurs in 50-70% of bone marrow transplantation patients, the most frequent ocular complication being keratoconjunctivitis sicca (KCS). Calcareous corneal degeneration is a type of calcium deposition that can be secondary to chronic ocular inflammation or dry eye, but there are few cases reported of acute calcareous corneal degeneration and recurrent perforation in cGVHD. Abbreviations: GVHD = Chronic graft-versus-host disease, aGVHD = Acute graft-versus-host disease, cGVHD = Chronic graft-versus-host disease, KCS = Keratoconjunctivitis sicca, PKP = Penetrating keratoplasty, AMT = Amniotic membrane transplantation, PRGF = Plasma rich in growth factors, OD = Right eye, OS = Left eye.
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21
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Mudaraddi N, Radhakrishnan N, Prajna NV, Kochar P. A rare case of acute stromal rejection following deep anterior lamellar keratoplasty in a steroid responder with keratoconus and vernal keratoconjunctivitis. Indian J Ophthalmol 2024; 72:145-147. [PMID: 38131596 PMCID: PMC10841782 DOI: 10.4103/ijo.ijo_1799_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Ninad Mudaraddi
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Naveen Radhakrishnan
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - N Venkatesh Prajna
- Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Prabhleen Kochar
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Vanathi M. Tissue addition keratoplasty in keratoconus: Trends and concerns. Indian J Ophthalmol 2024; 72:1-2. [PMID: 38131560 PMCID: PMC10841780 DOI: 10.4103/ijo.ijo_3157_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- M Vanathi
- Cornea & Ocular Surface, Cataract & Refractive Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. E-mail:
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Bernardes L, Gil J, Costa E, Tavares C, Rosa A, Quadrado MJ, Murta J. Topical tacrolimus in high-risk corneal transplants. Eur J Ophthalmol 2024; 34:140-145. [PMID: 37128645 DOI: 10.1177/11206721231172236] [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: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to assess the use of topical tacrolimus ointment in preventing rejection in high-risk corneal grafts, when added to the standard immunosuppressive regimen. METHODS We conducted an observational, retrospective study using clinical data of high-risk patients subjected to penetrating keratoplasty, who were treated with topical tacrolimus ointment 0.2 mg/g twice a day plus topical dexamethasone 0.1 mg/ml 6 id and compared it with a similar control group treated with topical dexamethasone 0.1 mg/ml 6 id alone. High-risk status was attributed to patients with previous ipsilateral corneal graft failure, two or more quadrants with corneal neovascularization or an infectious or inflammatory corneal disease. RESULTS We analysed 53 patients in the trial group versus 53 patients in the control group, with similar age, baseline diagnosis and risk factors, and median follow-up times of 30 and and 24 months, respectively. Survival analysis showed a higher graft survival rate at all follow-up periods for patients treated with topical tacrolimus (p < 0.01). No adverse reactions were reported. DISCUSSION This study shows that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen in high-risk patients. CONCLUSION Topical tacrolimus is safe and effective in prolonging graft survival in high-risk patients.
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Affiliation(s)
- Luís Bernardes
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - João Gil
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Esmeralda Costa
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Cristina Tavares
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Andreia Rosa
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Quadrado
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joaquim Murta
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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24
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Gheorghe AG, Arghirescu AM, Coleașă A, Onofrei AG. The surgical management of a patient with Fuchs endothelial dystrophy and cataracts. Rom J Ophthalmol 2024; 68:75-80. [PMID: 38617716 PMCID: PMC11007553 DOI: 10.22336/rjo.2024.15] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 04/16/2024] Open
Abstract
Objective: To report the two different surgical approaches in the case of a patient with Fuchs endothelial dystrophy with low endothelial cell count and advanced cataracts. Methods: The chosen surgical approach differed between eyes, with the right eye undergoing a combined approach consisting of cataract surgery, intraocular lens implantation, and penetrating keratoplasty in 2022. One year later, for the left eye, a different approach was decided: cataract surgery followed by Descemet membrane endothelial keratoplasty (DMEK). The Descemet membrane graft was prepared by the surgeon using the liquid bubble technique. AS-OCT was used to monitor the patient before and after surgery. Results: Visual recovery was excellent for both eyes, however, visual acuity improved quickly in the left eye (DMEK), while, in the right eye (PK), the best corrected visual acuity was reached after several months post-surgery. Conclusion: Advanced stages of Fuchs dystrophy patients will most likely need corneal transplantation. Each type of corneal transplantation procedure comes with unique challenges, both intraoperative and postoperative. DMEK is a very good treatment option for patients with Fuchs endothelial dystrophy, with excellent visual recovery and good graft survival at the 10-year mark. Abbreviations: DMEK = Descemet membrane endothelial keratoplasty, PK = penetrating keratoplasty, AS-OCT = anterior segment optical coherence tomography, FECD = Fuchs endothelial corneal dystrophy, BCVA = best corrected visual acuity, US = ultrasound, CDE = cumulative dissipated energy, IOL = intraocular lens.
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Affiliation(s)
- Alina Gabriela Gheorghe
- Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Bucharest, Romania
| | - Ana Maria Arghirescu
- Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Bucharest, Romania
| | - Andrei Coleașă
- Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Bucharest, Romania
| | - Ancuța Georgiana Onofrei
- Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Bucharest, Romania
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25
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Oganesyan OG, Gusak DA, Makarov PV, Ashikova PM. [Intracorneal selective stromal transplantation]. Vestn Oftalmol 2024; 140:86-92. [PMID: 38450471 DOI: 10.17116/oftalma202414001186] [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: 03/08/2024]
Abstract
Deep anterior lamellar keratoplasty or penetrating keratoplasty are currently considered the optimal methods of surgical treatment of stromal dystrophies and corneal degeneration. Despite certain advantages and benefits of these methods, they also have significant limitations: involvement of superficial corneal layers in the surgery, need for suturing, development of post-keratoplasty astigmatism etc. PURPOSE This study aimed to test and describe the new method of closed sutureless keratoplasty (intracorneal selective stromal transplantation), which was indicated in isolated dystrophic and degenerative pathology of the stroma. MATERIAL AND METHODS Intracorneal selective stromal transplantation was performed in a 62-year-old patient with stromal degeneration and intact corneal layers between the altered stroma and the Descemet's membrane posteriorly, and the Bowman's layer anteriorly. The patient also had immature senile cataract. Corneal stroma was removed and replaced with a graft in the optical center of the lens, while the endothelium, the Descemet's membrane and the Bowman's layer remained intact. RESULTS The proposed technique of intracorneal selective stromal transplantation makes it possible to replace only the pathologically altered stroma through closed surgical approach, without affecting the anterior and posterior surfaces of the cornea. Best-corrected visual acuity has increased in the patient from 0.01 to 0.6, while mean endothelial cell density has not changed in the course of 24-months follow-up. CONCLUSION The proposed keratoplasty method can be used in patients with dystrophy or degeneration of the corneal stroma and preserved endothelial cells, intact Descemet's membrane and Bowman layer. Since the superficial corneal layers are not involved during the surgery, intracorneal selective stromal transplantation combined the advantages of both deep anterior lamellar keratoplasty and endothelial keratoplasty. The biologically favorable result in this first clinical case allows a preliminary conclusion on the technical possibility and functional effectiveness of the proposed method, but further long-term observation and more clinical cases are required.
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Affiliation(s)
- O G Oganesyan
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - D A Gusak
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - P V Makarov
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - P M Ashikova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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26
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Incandela C, D'Oria F, Lapenna L, Acquaviva A. Penetrating keratoplasty in brittle Cornea syndrome: Case series and review of the literature. Eur J Ophthalmol 2024; 34:11-17. [PMID: 37073081 DOI: 10.1177/11206721231171426] [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: 04/20/2023]
Abstract
It concerns three siblings (two 28 year old twin boys and a 25 year old woman) who presented a previous history of rupture of eyeball in one eye and very poor vision in the other. At the first ophthalmoscopic and instrumental evaluation, three patients presented with bluish sclera and keratoglobus in the intact eye. A genetic analysis with whole exome sequencing was then performed on the three siblings, identifying a biallelic variant of the PRDM5 gene that led to the diagnosis of Brittle Cornea Syndrome (BCS), a rare autosomal recessive disorder characterized by corneal thinning and blue sclera. To preserve the only intact eye from possible breakage, the three siblings were trained in using protective measures (polycarbonate goggles etc.) to carry out close monitoring of symptoms and were asked to continue with follow-up visits for ocular and systemic diseases associated with BCS. Given the poor best corrected visual acuity achievable with glasses and contact lenses, penetrating keratoplasty was performed, achieving good visual acuity maintained in the 2-year follow-up in two of the three patients. Knowledge of this pathology and its clinical manifestations is essential for early diagnosis and correct management of this rare but very debilitating pathology. To our knowledge, this is the first case series of BCS reported in an Albanian population.
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Affiliation(s)
- Cosimo Incandela
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
| | - Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Lucia Lapenna
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
| | - Antonio Acquaviva
- Department of Ophthalmology, Di Venere's Hospital of Bari, Bari City, Italy
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27
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Soiberman US, Jun AS. More support for deep anterior lamellar keratoplasty over penetrating keratoplasty for keratoconus, but questions remain. Br J Ophthalmol 2023; 108:1-2. [PMID: 37890881 DOI: 10.1136/bjo-2023-324685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
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28
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Singh RB, Li J, Parmar UPS, Jeng BH, Jhanji V. Vaccine-associated corneal graft rejection following SARS-CoV-2 vaccination: a CDC-VAERS database analysis. Br J Ophthalmol 2023; 108:17-22. [PMID: 36575625 DOI: 10.1136/bjo-2022-322512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/05/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the cases of corneal graft rejection following SARS-CoV-2 vaccination reported to Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System. METHODS A descriptive analysis of the demographics, clinical history and presentation was performed. We evaluated the correlation between the vaccines and duration of vaccine-associated graft rejection (VAR) onset following vaccination using a one-way analysis of variance test. A post hoc analysis was performed between VAR onset-interval following vaccination dose and vaccine type. Finally, a 30-day cumulative incidence analysis was performed to assess the risk of VAR in short term following different doses, vaccines and type of corneal transplantation. RESULTS A total of 55 eyes of 46 patients were diagnosed with VAR following vaccination with BNT162b2 (73.91%) and mRNA-1273 (26.09%). The mean age of the patients was 62.76±15.83 years, and 28 (60.87%) were female. The patients diagnosed with VAR had undergone penetrating keratoplasty (61.82%), Descemet membrane endothelial keratoplasty (12.73%), descemet stripping endothelial keratoplasty (18.18%), anterior lamellar keratoplasty (3.64%) and corneal limbal allograft transplantation (1.82%). The mean time for VAR since penetrating and endothelial keratoplasty was 8.42±9.23 years and 4.18±4.40 years, respectively. 45.65% of the cases of VAR were reported after the second dose of vaccine. The duration of VAR onset was significantly shorter after the second dose compared with the first and booster doses (p=0.0165) and in patients who underwent endothelial keratoplasty compared with penetrating keratoplasty (p=0.041). CONCLUSIONS This study outlines a possible temporal relationship between corneal graft rejection and SARS-CoV-2 vaccination. An earlier onset of VAR was observed in patients who had a history of endothelial keratoplasty and following the second dose of vaccination.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Ophthalmology and Visual Sciences, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Jeffrey Li
- Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Bennie H Jeng
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vishal Jhanji
- Eye and Ear Insitute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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29
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Gurnani B, Kaur K. Understanding barriers, recommended solutions, and future prospects for the diagnosis and management of Pythium insidiosum keratitis. Indian J Ophthalmol 2023; 71:3584-3586. [PMID: 37991287 PMCID: PMC10788758 DOI: 10.4103/ijo.ijo_1041_23] [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: 04/20/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 11/23/2023] Open
Abstract
Pythium insidiosum keratitis (PIK) is a devastating corneal infection resulting in blindness in a large number of cases. Clinically and morphologically, it closely mimics fungal keratitis, and hence is also labeled as "parafungus." Although many clinical studies have documented evidence regarding the virulence of microorganism, and anatomical and functional outcomes, it remains a clinical challenge and diagnostic dilemma for most clinicians. Till today, PIK is being diagnosed and treated with certainty at only limited centers across the globe. But the question is why this is so? Taking this as the research question, this section on current ophthalmology aims to highlight the understanding of barriers to diagnosing and treating PIK, the suggestions to improve diagnosis and treatment, and the future prospects.
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Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, Trauma, External Disease, Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
| | - Kirandeep Kaur
- Cataract, Pediatrics Ophthalmology and Strabismus Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
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Singh NK, Barik MR, Das S, Sahu SK, Priyadarshini SR, Sharma S, Sahu SS, Behera HS. Case Series: Mixed Infectious Keratitis by Pythium insidiosum and Fungal Species. Optom Vis Sci 2023; 100:887-894. [PMID: 38019963 DOI: 10.1097/opx.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
SIGNIFICANCE This case series is the first to illustrate mixed infection from Pythium sp. and fungal species in corneal ulcer. PURPOSE This case series aimed to alert all toward the possibility of both Pythium sp. and fungal species infection in case of nonresponding corneal ulcer treated with either antifungals or antipythium drugs alone. Increased suspicion of mixed infection in case of nonresponding fungal/ Pythium keratitis may facilitate early and prompt management. CASE REPORTS Six patients presented with signs of either fungal or Pythium keratitis. They underwent ophthalmological examinations, smear examinations, cultures, and polymerase chain reaction (PCR). Therapeutic penetrating keratoplasty was performed in cases where symptoms worsened after treatment with either antifungal or antipythium drugs. The half corneal button (HCB) was shared for histopathological and microbiological examinations. In the first case, smear examination from corneal scraping (CS) revealed Pythium -like filaments, which were confirmed with PCR; however, Aspergillus nidulans grew in culture. In the second case, iodine-potassium iodide (IKI) staining was positive for Pythium ; however, PCR was positive for both Pythium and fungus, which was further confirmed by DNA sequencing. In the third case, IKI staining and HCB were positive for Pythium ; however, PCR was positive for fungus, which was identified as Candida saitoana with DNA sequencing. In the fourth case, Pythium grew in the CS culture; however, Candida sp. grew in the HCB culture. In the fifth case, Cladosporium sp. grew in culture from CS; however, Pythium insidiosum grew from the anterior chamber exudate after therapeutic penetrating keratoplasty. In the sixth case, smear examination revealed septate fungal filaments, and Cladosporium sp. grew in culture; however, HCB on histopathological examination showed features of Pythium keratitis. CONCLUSIONS In unresponsive cases of Pythium or fungal keratitis, diagnostic modalities such as IKI and PCR should be implemented as a routine practice, in addition to smears and cultures.
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Akannour Y, El Majdoubi El Idrissi K, Serghini L, Elhassan A, Berraho A. [Descemetic detachment post-DALK without corneal edema]. J Fr Ophtalmol 2023; 46:e396-e397. [PMID: 37865537 DOI: 10.1016/j.jfo.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Y Akannour
- Département d'ophtalmologie B, hôpital des spécialités, université Mohammed V, CHU Ibn Sina, 10000 Rabat, Maroc.
| | - K El Majdoubi El Idrissi
- Département d'ophtalmologie B, hôpital des spécialités, université Mohammed V, CHU Ibn Sina, 10000 Rabat, Maroc.
| | - L Serghini
- Département d'ophtalmologie B, hôpital des spécialités, université Mohammed V, CHU Ibn Sina, 10000 Rabat, Maroc
| | - A Elhassan
- Département d'ophtalmologie B, hôpital des spécialités, université Mohammed V, CHU Ibn Sina, 10000 Rabat, Maroc
| | - A Berraho
- Département d'ophtalmologie B, hôpital des spécialités, université Mohammed V, CHU Ibn Sina, 10000 Rabat, Maroc
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Nkanga ED, Umana UE, Ibanga AA, Nkanga ED, Ezeh EI, Ani EU, Nkanga DG, Etim BA, Akpan SI. Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences. Niger J Clin Pract 2023; 26:1772-1776. [PMID: 38044787 DOI: 10.4103/njcp.njcp_459_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 12/05/2023]
Abstract
ABSTRACT The burden of avoidable blindness from corneal disease is significantly higher where access to specialist eye care, the cost of treatment and the treatment infrastructure including eye banking, are beyond the reach of the impoverished masses. Corneal transplantation in children is challenging: it is more technically complex; patients often require multiple examinations under general anaesthesia to optimize treatment outcomes. There is also the increased risk of several complications including graft dehiscence, infection, rejection, and inappropriate patient or caregiver care. However, when successful, it restores vision. We present a report of our initial experience with penetrating keratoplasty in 2 children with blinding corneal disease in Uyo, Nigeria. Corneal transplantation history was retrieved and data (including data on age, sex, aetiology of corneal disease, indications for corneal transplantation, pre-operative and post-operative visual acuity and intraocular pressure measurements) was extracted for this report. Both patients had standard penetrating keratoplasty performed by one surgeon, under general anaesthesia. Case one was a 10-year-old male presenting with profound visual impairment from congenital hereditary endothelial dystrophy. His best corrected post-operative visual acuity was 6/24. Case two was a 3-year-old male with vision loss due to a corneal leucoma following treated herpes simplex keratitis. Post-operatively, his best corrected visual acuity improved to 6/12. Corneal graft tissue remained clear at more than 3 years of follow-up. Although amblyopia was a notable co-morbidity, corneal transplantation significantly improved their vision. Corneal banking services are advocated for in resource-limited settings where the magnitude of corneal blindness is greatest.
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Affiliation(s)
- E D Nkanga
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ui E Umana
- Department of Ophthalmology, Marion Eye Centre, Marion, Illinois, USA
| | - A A Ibanga
- Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - E D Nkanga
- Department of Pediatrics, All Saints University of Medicine, Common Wealth of Dominica, Rivers State, Nigeria
| | - E I Ezeh
- Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - E U Ani
- Department of Ophthalmology, The Ophthalmic Specialists, Port Harcourt, Rivers State, Nigeria
| | - D G Nkanga
- Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - B A Etim
- Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - S I Akpan
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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33
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Lucisano A, Scorcia V, Taloni A, Rossi C, Gioia R, Giannaccare G. Impact of topographic localization of corneal ectasia on the outcomes of deep anterior lamellar keratoplasty employing large (9 mm) versus conventional diameter (8 mm) grafts. Eye (Lond) 2023; 37:3477-3483. [PMID: 37081075 PMCID: PMC10630389 DOI: 10.1038/s41433-023-02536-6] [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: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES Visual and topographic outcomes of large (9.0 mm) versus conventional (8.0 mm) deep anterior lamellar keratoplasty (DALK) for the treatment of keratoconus (KC) were compared in relation to the different localization of the corneal ectasia (within or beyond the central 8.0 mm). METHODS This is a retrospective, comparative case series. Preoperatively, the topographic extension of the conus was calculated by measuring the distance from the geometric center of the cornea and the outermost point of the corneal ectasia (ectasia <8.0 mm, group A; ectasia ≥8.0 mm, group B). DALK was performed using both small grafts (8.0 mm, group 1) and large grafts (9.0 mm, group 2). Best-corrected visual acuity and topographic astigmatism were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1). RESULTS Data from 224 eyes of 196 patients (mean age 37.6 ± 15.1 years) were evaluated. Topographic astigmatism improved from T0 to T1 (4.94 ± 2.92 diopters (D) [95% CI, 4.56-5.33] vs 4.19 ± 2.45 D [95% CI, 3.87-4.51], p = 0.001). There was no significant difference in postoperative topographic cylinder between group 1 and group 2 when considering eyes with corneal ectasia <8.0 mm (group 1 A, 4.15 ± 2.19 D [95% CI, 3.64-4.66] vs group 2 A, 3.65 ± 2.13 D [95% CI, 2.92-4.38], p = 0.14); conversely, the difference was significant considering eyes with corneal ectasia ≥8.0 mm (group 1B, 4.74 ± 2.90 D [95% CI, 4.09-5.38] vs group 2B, 3.68 ± 1.94 D [95% CI, 3.10-4.26], p = 0.02). CONCLUSIONS Large 9.0-mm DALK provided better anatomical outcomes compared to conventional 8.0-mm DALK, particularly in eyes with corneal ectasia extending beyond the central 8.0 mm.
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Affiliation(s)
- Andrea Lucisano
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy.
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Raffaella Gioia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
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Fathai H, Geerling G, Menzel-Severing J. Indications and outcomes of keratoplasty ≤ 5.5 mm diameter ("mini-keratoplasty"). BMC Ophthalmol 2023; 23:408. [PMID: 37817122 PMCID: PMC10563242 DOI: 10.1186/s12886-023-03150-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
PURPOSE To report indications and clinical outcomes of corneal grafts ≤ 5.5 mm in diameter ("mini-KP") in a German tertiary referral center. METHODS Patients who had undergone mini-KP to treat corneal ulcers with or without perforation between 2011 and 2018 at the Department of Ophthalmology, University of Düsseldorf, Germany, were identified from the local keratoplasty registry. All patient records were reviewed for age, gender, laterality, systemic and ophthalmological diseases, etiology of the corneal ulcerative disease, pre- and postoperative visual acuity over a follow-up time of up to 12 months, graft size, postoperative complications and the need for and timing of further corneal interventions. RESULTS 37 eyes of 37 patients (male: n = 20; female: n = 17) with a mean age (± standard deviation) at presentation of 70 ± 18.8 years (range: 22-92 years) were identified. Most common etiologies were neurotrophic keratopathy (n = 15), dysfunctional tear syndrome (n = 9) and atopic keratoconjunctivitis (9). Mean graft diameter was 4.51 ± 0.63 mm (range: 3-5.5 mm). 23/37 eyes (62%) required no further intervention in the acute phase. 14/37 patients (38%) required secondary corneal intervention, due to complications. One-year graft survival was 78.4%. One eye had to be eviscerated due to recurrent corneal ulceration and endophthalmitis. 36 of 37 eyes were preserved. We found a highly significant correlation between type 2 diabetes and the development of postoperative complications (r = .46; p = .005). Corrected distance visual acuity (CDVA) improved from 1.42 ± 0.75 logMAR to 0.9 ± 0.65 logMAR postoperatively (t (23) = 5.76; p < .001). CONCLUSION Mini-KP can be used successfully in eyes with advanced corneal ulcers due to various infectious and noninfectious etiologies to restore tectonic stability in the long-term and with moderate visual gains.
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Affiliation(s)
- Hila Fathai
- Department of Ophthalmology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Shalaby WS, Shukla AG, Shiuey EJ, Rapuano CJ, Nagra PK, Syed ZA. Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes. Cornea 2023; 42:1274-1279. [PMID: 36729026 DOI: 10.1097/ico.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to determine possible associations between demographic and socioeconomic factors and graft survival after penetrating keratoplasty (PK). METHODS This study was a retrospective chart review of patients undergoing PK at a tertiary-care corneal practice at Wills Eye Hospital between May 1, 2007, and September 1, 2018. The first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Demographic and socioeconomic factors included yearly average adjusted gross income (AGI) based on residential zip code, age, sex, and race. Two income groups were created: 1) individuals from neighborhoods with the lowest 10% of AGI (N = 82, AGI=$32,100 ± 4000) and 2) the remaining 90% of individuals (N = 740, AGI=$86,900 ± 52,200). Logistic regression analysis was performed to identify factors predictive of graft prognosis. RESULTS The 822 patients (822 eyes) included had a mean age of 57.1 ± 22.1 years at the time of PK. Over an average of 4.2 ± 3.1 years of follow-up, graft failure occurred in 35.3%. Age, sex, and follow-up duration were comparable between income groups (all P > 0.05). Black race was disproportionately represented in the lower-income group (50.0% vs. 11.5%, P < 0.001). Multivariable analysis identified predictors of graft failure including residing in a lower-income neighborhood [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.24-4.19, P = 0.008], younger age (HR = 0.99, 95% CI = 0.98-1.00, P = 0.046), and Black race (HR = 1.63, 95% CI = 1.03-2.56, P = 0.035). CONCLUSIONS Individuals with a lower income, younger age, and Black race may be more vulnerable to graft failure after PK. Further studies are warranted to identify reasons for these associations.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt; and
| | - Aakriti Garg Shukla
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric J Shiuey
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher J Rapuano
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Parveen K Nagra
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zeba A Syed
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Roberts PK, Keane M, Yang G, Chan E, Harkin DG, McKirdy N, Daniell M. Comparison of penetrating and endothelial keratoplasty in patients with iridocorneal endothelial syndrome: A registry study. Clin Exp Ophthalmol 2023; 51:663-672. [PMID: 37608637 DOI: 10.1111/ceo.14283] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND To compare graft survival of endothelial keratoplasty (EK) versus penetrating keratoplasty (PK) in patients with iridocorneal endothelial (ICE) syndrome and identify ocular features associated with graft survival. METHODS Observational, prospective, cohort study. A total of 30 806 first grafts performed between 1985 and 2020 were identified through the Australian Corneal Graft Registry and included in this observational, prospective cohort study. A total of 196 eyes underwent a primary corneal graft for ICE syndrome. Kaplan-Meier graft survival plots and Chi-squared tests were performed to identify graft survival rates for EK and PK. A history of raised intraocular pressure (IOP) was also recorded and analysed. Graft survival of eyes with ICE syndrome were compared to that of other indications. RESULTS Grafts performed for ICE syndrome increased to 0.8% of all cases during the 2005 to 2020 period compared with 0.5% between 1985 to 2004 (χ2 =9.35, p = 0.002). From 2010, EK surpassed PK as the preferred graft type. Survival of primary grafts in eyes with ICE syndrome was lower than for other indications (log-rank = 56.62, p < 0.001). Graft survival was higher following PK than Descemet stripping (automated) endothelial keratoplasty (DS(A)EK) (log-rank = 10.56, p = 0.001). Graft survival was higher in eyes without a history of raised IOP compared to those with a reported history of raised IOP (log-rank = 13.06, p < 0.001). CONCLUSIONS ICE syndrome carries a poor prognosis for graft survival. DS(A)EK had a poorer prognosis than PK. A history of raised IOP is associated with higher risk of graft failure.
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Affiliation(s)
- Philipp K Roberts
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Miriam Keane
- Australian Corneal Graft Registry, Department of Ophthalmology, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gink Yang
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Elsie Chan
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien G Harkin
- School of Biomedical Sciences, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natalie McKirdy
- School of Biomedical Sciences, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Daniell
- Corneal Unit, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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Bolac R, Ozcelik-Kose A, Imamoglu S, Yildiz E, Ozturk Y, Mangan MS. Evaluation of Schlemm Canal Parameters Using Swept-Source Optical Coherence Tomography in Eyes That Underwent Keratoplasty. Eye Contact Lens 2023; 49:379-385. [PMID: 37418302 DOI: 10.1097/icl.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups. METHODS The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal. RESULTS There was no statistically significant difference between the groups for age and gender ( P ˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141μm 2 and 160.77±65.08 μm, respectively, in the nasal quadrant and 2.623±1.277 μm 2 and 158.81±68.05 μm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups ( P <0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters. CONCLUSION This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.
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Affiliation(s)
- Ruveyde Bolac
- Department of Ophthalmology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital (R.B., A.O-K., S.I., M.S.M.), Istanbul, Turkey; North American Lasik and Eye Surgery Center (E.Y.), Dubai, United Arab Emirates; and Dunya Goz Hospital (Y.O.), Istanbul, Turkey
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Sorkin N, Hatch W, Mimouni M, Chew HF, Rootman DS, Slomovic AR, Bujak MC, Chan CC, Thorpe KE, Perez M, Stiuso V, Singal N. A randomized controlled trial comparing femtosecond-enabled deep anterior lamellar keratoplasty and standard deep anterior lamellar keratoplasty (FEDS Study). Eye (Lond) 2023; 37:2693-2699. [PMID: 36693916 PMCID: PMC10482827 DOI: 10.1038/s41433-023-02387-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To compare outcomes of femtosecond-enabled deep anterior lamellar keratoplasty (FE-DALK) and standard deep anterior lamellar keratoplasty (S-DALK). METHODS An open label, randomized controlled trial (Kensington Eye Institute, Toronto, ON, Canada) including 100 eyes of 97 participants with either keratoconus or corneal scarring, randomized to either FE-DALK (n = 48) or S-DALK (n = 49). PRIMARY OUTCOMES postoperative astigmatism and surgically induced corneal astigmatism (SIA) - both at 15 months. SECONDARY OUTCOMES 6-, 12- and 15-month postoperative uncorrected- and best spectacle-corrected visual acuity, steep and flat keratometry, manifest sphere and astigmatism, rate of conversion to penetrating keratoplasty (PK), big-bubble success, central corneal thickness, endothelial cell count and complications. RESULTS In intention-to-treat analysis, mean postoperative astigmatism in the FE-DALK (n = 30) and S-DALK (n = 30) groups at 15 months was 7.8 ± 4.4 D and 6.3 ± 5.0 D, respectively (p = 0.282) with an adjusted mean difference of 1.3 D (95% CI -1.08, +3.65). Mean SIA (arithmetic) was 9.2 ± 7.8 and 8.8 ± 5.4 D, respectively (p = 0.838) with a mean difference of 0.4 D (95% CI -3.13, +3.85). In an analysis of successful DALK cases only, mean postoperative astigmatism in the FE-DALK (n = 24) and S-DALK (n = 20) groups at 15 months (after excluding 4 eyes with AEs) was 7.3 ± 4.4 and 6.2 ± 4.9 D, respectively (p = 0.531) with an adjusted mean difference of 0.9 D (95% CI -1.94, +3.71). Mean SIA (arithmetic) was 9.1 ± 7.8 and 7.9 ± 4.6 D, respectively (p = 0.547) with a mean difference of 1.2 D (95% CI -2.70,+5.02). Comparison of secondary outcomes showed only weak statistical evidence. CONCLUSIONS In this randomized controlled trial, FE-DALK and S-DALK showed comparable functional and anatomical outcomes.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Matthew C Bujak
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre (AHRC), Toronto, ON, Canada
| | - Mauricio Perez
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Vera Stiuso
- Kensington Eye Institute, Toronto, ON, Canada
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
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Chen J, Elhusseiny AM, Khodeiry MM, Smith MP, Sayed MS, Banitt M, Feuer W, Yoo SH, Lee RK. Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty. J Glaucoma 2023; 32:800-806. [PMID: 37171992 PMCID: PMC10524893 DOI: 10.1097/ijg.0000000000002239] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/12/2023] [Indexed: 05/14/2023]
Abstract
PRCIS We evaluated the factors that impacted time from glaucoma drainage implant (GDI) surgery to penetrating keratoplasty (PK) in eyes with previously clear corneas (ie, GDI-first sequence), and that specifically underwent a trabeculectomy before GDI surgery for intraocular pressure (IOP) control. PURPOSE To describe through an event-triggered data collection method the clinical course and the long-term outcomes of 2 procedures that are commonly performed sequentially in complex clinical situations: GDI surgery and PK. The study investigates the clinical factors associated with the progression to PK and determines the GDI success rate and graft survival. METHODS A single, tertiary-care center retrospective interventional cases series including patients with a sequential history of trabeculectomy, GDI surgery, and PK from 1999 to 2009. Outcome measures included IOP, visual acuity, graft failure, GDI failure, and time from GDI to PK. RESULTS Of the eyes, 56% had primary open angle glaucoma. The time from the last trabeculectomy to GDI was 66.5 ± 66.7 months. Of the eyes, 84% received a Baerveldt GDI. Time from GDI to PK was 36.4 ± 28.4 months. IOP at the time of PK was between 5 mm Hg and 21 mm Hg in 90% of eyes. At the last follow-up, 48% of grafts were clear. At 5 years post-PK, 33% of corneal grafts remained clear, whereas 81% of tubes remained functional. CONCLUSIONS Nearly half of the corneal grafts are clear at the last long-term follow-up. Graft failure occurs at a higher rate than tube failure suggesting that IOP control is only one and possibly not the most important factor in graft survival in eyes with prior glaucoma surgery.
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Affiliation(s)
- Jessica Chen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Palo Alto Eye Group, 1805 El Camino Real, Palo Alto, CA 94306
| | - Abdelrahman M. Elhusseiny
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - Mohamed M. Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P. Smith
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Eye Consultants of PA, 1 Granite Point, Wyomissing, PA 19610
| | - Mohamed S. Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Moorfields Eye Hospital, Dubai, UAE
| | - Michael Banitt
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Northwest Eye Surgeons, 332 Northgate Way, Seattle, WA 98125
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Richard K. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
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Kaur A, Parida P, Priyadarshini SR, Mohanty A, Sahu SK, Das S. Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India. Indian J Ophthalmol 2023; 71:3166-3170. [PMID: 37602603 PMCID: PMC10565916 DOI: 10.4103/ijo.ijo_2636_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/24/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011-2020) in a tertiary eye care center of eastern India. Methods A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Results Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full-thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full-thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). Conclusion With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full-thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period.
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Affiliation(s)
- Amanjot Kaur
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Priyadarsani Parida
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Amrita Mohanty
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Ng PY, Ahmad MJ, Ismail F, Lott PW, Singh S. Unusual presentation of infectious crystalline keratopathy: A case report with literature review. Eur J Ophthalmol 2023; 33:NP83-NP86. [PMID: 36325679 DOI: 10.1177/11206721221136329] [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: 08/31/2023]
Abstract
INTRODUCTION Infectious crystalline keratopathy (ICK) is a rare corneal disease. ICK has been recognised in patients with immunocompromised cornea or post penetrating keratoplasty. Here we report a case of ICK in an apparently healthy cornea. CASE DESCRIPTION A 25-years old Chinese female, with no history of systemic or ocular disease, presented to the eye clinic with one-month history of right eye (RE) blurring of vision with foreign body sensation. On examination, there were dense white crystalline needle-like projections over inferior paracentral corneal stroma with intact epithelium. There was also presence of lower eyelid epiblepharon with lashes rubbing against the diseased area. Corneal scraping cultures were suggestive of bacterial infection. Patient responded well with corneal epithelium debridement, intensive topical antibiotics and epiblepharon correction to prevent further microtrauma. CONCLUSIONS The only contributing factor for ICK in our patient was trichiasis from epiblepharon. Repetitive microtrauma caused by the eyelashes lead to direct penetration and inoculation of normal ocular flora into the corneal stroma. Clinicians need to be vigilant in ruling out other possible causes such as lid abnormalities when managing an ICK patient without apparent risk factors.
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Affiliation(s)
- Pey Yih Ng
- UM Eye Research Centre, Department of Ophthalmology, University of Malaysia, Kuala Lumpur, Malaysia
| | - Marium J Ahmad
- UM Eye Research Centre, Department of Ophthalmology, University of Malaysia, Kuala Lumpur, Malaysia
| | - Fazliana Ismail
- UM Eye Research Centre, Department of Ophthalmology, University of Malaysia, Kuala Lumpur, Malaysia
| | - Pooi Wah Lott
- UM Eye Research Centre, Department of Ophthalmology, University of Malaysia, Kuala Lumpur, Malaysia
| | - Sujaya Singh
- UM Eye Research Centre, Department of Ophthalmology, University of Malaysia, Kuala Lumpur, Malaysia
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Berger T, Seitz B, Hamon L, Flockerzi F, Schlötzer-Schrehardt U, Daas L. Ultrastructural Examination of the Corneal Interface after Predescemetic Deep Anterior Lamellar Keratoplasty (DALK) - A Case Report with Light and Transmission Electron Microscopy. Klin Monbl Augenheilkd 2023; 240:1010-1016. [PMID: 35320861 DOI: 10.1055/a-1745-9140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine corneal buttons with light and transmission electron microscopy (TEM) to visualize the interface area and highlight the ultrastructural corneal changes after deep anterior lamellar keratoplasty (DALK). METHODS Two patients underwent excimer laser-assisted penetrating repeat keratoplasty after predescemetic DALK. The corneal buttons were examined by light microscopy and TEM. RESULTS The light microscopic examination of the corneal buttons revealed fragments of a second Descemet's membrane in the central and midperipheral areas (Case 1). In both cases, visualization of the interface area was not possible by light microscopy. The donor and host stroma were tightly attached without dehiscence. TEM identified the interface area by irregularities in the collagen distribution between the donor and host stroma. The thickness of the remaining recipient corneal stroma measured approximately 30 µm (Case 1) and 100 µm (Case 2), respectively. In the host stroma, TEM revealed the absence or degeneration of keratocytes, accumulation of amorphous material between the collagen lamellae, and vacuolar inclusions dispersed in the stroma, forming a band-like zone anterior to Descemet's membrane. CONCLUSION The interface area after DALK has been mainly investigated by in vivo confocal microscopy. Light microscopy and TEM findings indicate remodeling processes after DALK that are associated with increased keratocyte degeneration and structural alterations of the extracellular matrix in the host stroma. The choice of surgical method may influence the postoperative morphological and functional outcome since these findings were primarily apparent in the remaining host stroma. Therefore, complete exposure of Descemet's membrane is an important prognostic factor for the postoperative visual outcome.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | | | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
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Rathi A, Ramazanova K, Murthy SI, Mohamed A, Joseph J, Doctor MB, Pandey S, Rathi VM. Clinical and Microbiological Spectra and Therapeutic Outcomes of Polymicrobial Keratitis. Cornea 2023; 42:946-953. [PMID: 35965400 DOI: 10.1097/ico.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the risk factors, microbiology, and treatment outcomes of polymicrobial keratitis (PMK). METHODS We retrospectively analyzed 65 patients diagnosed with PMK between 2016 and 2019. The clinical and microbiological characteristics and outcomes were evaluated. The primary outcome measure was clinical resolution of keratitis. Absolute success (group A) was defined as resolution of infection with medical treatment, qualified success (group B) was resolution with medical therapy and additional minor procedures, and failure (group C) was defined as worsening of infection and presence of corneal melting or perforation requiring therapeutic penetrating keratoplasty or evisceration. RESULTS Of 4764 cases of microbial keratitis, PMK was identified in 65 eyes of 65 patients (1.36%). Infiltrate was central in 60% (39 eyes). Predisposing factors were higher in group C and included uncontrolled diabetes mellitus in 25% (7/28), history of trauma/foreign body in 57.1% (16/28), and poor presenting visual acuity (0.9 for group A vs. 1.79 for group B vs. 3.00 logarithm of the minimum angle of resolution for group C; P = 0.02). Microbiological profiling revealed that a majority (95%: 62/65) had bacterial with fungal keratitis. High fluoroquinolone resistance was noted (57%; 34/59). Absolute success was achieved in 28.3% (17/60), qualified success in 16.6% (10/60), and treatment failure was noted in 55% (33/60). The final best corrected visual acuity in group A was significantly better than that in group B and C (0.44 vs. 3.00 vs. 2.78; P < 0.001). CONCLUSIONS PMK is extremely rare but responds poorly to medical therapy. Bacterial with fungal etiology is predominant. Early surgical intervention to improve overall outcome is advocated.
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Affiliation(s)
- Anubha Rathi
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | | | - Ashik Mohamed
- Ophthalmic Biophysics, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, India . and
- Ramoji Foundation for Ocular Infections (RFCOI), Hyderabad, India
| | | | - Suchita Pandey
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, India . and
| | - Varsha M Rathi
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
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Baydoun L. P45-A154 DMEK in complicated eyes: influence of donor characteristics, outcomes, and prognosis. BMJ Open Ophthalmol 2023; 8:A18. [PMID: 37604552 DOI: 10.1136/bmjophth-2023-eeba.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) has become the goldstandard in the treatment of Fuchs endothelial corneal dystrophy and early stages of (pseudophakic) bullous keratopathy due to the safer ´closed globe` surgery, the fast and excellent visual recovery and low complication rates. In those cases, DMEK can often be performed in a standardized manner. Given the outstanding clinical outcomes, the spectrum of indications has expanded in the past years: thus, also more complex cases, such as eyes with advanced corneal edema, altered anterior chamber anatomy, failed lamellar grafts, failed penetrating keratoplasty, as well as, phakic, aphakic and vitrectomized eyes are being treated with DMEK. Although DMEK surgery in complicated eyes proved feasible, the procedure is technically more challenging because of the impaired visualization during surgery and the unpredictable graft behaviour. Surgical strategies to accomplish DMEK in complex eyes have been suggested and customization of recipient/donor characteristics (donor age, graft size) may facilitate the surgery. Still, clinical outcomes appear not as good as in standard indications and there is uncertainty concerning the long-term graft survival.
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45
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Okonkwo A, Sethi K, Anand S. Repeated Intracameral Amphotericin B: A Safe Approach for Management of Fungal Anterior Chamber Reactivations After Therapeutic Penetrating Keratoplasty. Cornea 2023; 42:1041-1044. [PMID: 36961443 DOI: 10.1097/ico.0000000000003268] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/29/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The aim of this study was to describe the safe use of repeated intracameral amphotericin B for anterior chamber reactivations after therapeutic penetrating keratoplasty for Fusarium solani keratitis. METHODS A 49-year-old woman monthly soft contact lens wearer with a history of overuse and swimming in her lenses presented with a red painful left eye. Her vision was 0.5 logMAR and there was a poorly demarcated corneal infiltrate. Although corneal scrapes and a corneal biopsy were negative, confocal microscopy showed fungal hyphae. After failure of medical treatment, therapeutic penetrating keratoplasty was performed. Fusarium solani sensitive to amphotericin was isolated. There was pan-azole resistance. The patient was managed with topical amphotericin B, and repeated anterior chamber reactivations were managed with intracameral amphotericin B 5 µg in 0.1 mL on 9 occasions over 5 months after sensitivities were known. Topical cyclosporine was used as the sole immunomodulator postoperatively, with no topical steroid use over the 4-year follow-up period. RESULTS There were no episodes of graft rejection and no endothelial, lenticular, or retinal toxicity. The best-corrected visual acuity is -0.1 logMAR and the endothelial cell count is 2160/mm 2 . CONCLUSION This report describes the safe and effective use of repeated intracameral amphotericin (cumulative 45 µg) in anterior chamber reactivations after therapeutic penetrating keratoplasty and highlights the role of fungal sensitivity in guiding treatment in refractory cases. It also demonstrated the successful use of topical cyclosporin as the sole postoperative immunomodulatory therapy despite repeated recurrence of infection and consequent increased inflammation in the postoperative period.
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Affiliation(s)
- Arthur Okonkwo
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust; and
- School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, United Kingdom
| | - Kavita Sethi
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust; and
| | - Seema Anand
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust; and
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Rokohl AC, Roters S, Heindl LM, Cursiefen C. P35-A133 Novel eccentric corneoscleral donor preparation technique providing corneoscleral tectonic and central split corneal grafts for multiple recipients. BMJ Open Ophthalmol 2023; 8:A14. [PMID: 37604576 DOI: 10.1136/bmjophth-2023-eeba.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Today, split cornea technique is an established procedure and is mostly used for two recipients by combining deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) surgeries. However, for some surgical interventions including block excision with tectonic corneoscleral grafting, split cornea procedure is not planned regularly up to now. In the run-up for this procedure, normally a donor cornea with a bigger scleral ring is gained. Nonetheless, the preparation of the tectonic graft for covering the corneoscleral defect after block excision results in a rest donor cornea transplant which is normally too small for further regular size penetrating keratoplasties (PKs) or combined DALK/DMEK surgeries. However, using a modified donor transplant trephination technique, a corneoscleral transplant for regular size keratoplasties can be gained, also after preparation of a tectonic graft for block excision. Herein, we describe shortly this novel donor preparation technique, the differences compared to the standard procedure, possible applications, and the advantages and disadvantages for the first time.
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Affiliation(s)
| | - Sigrid Roters
- Department of Ophthalmology, University of Cologne, Germany
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Sharma S, Singh S, Shanbhag SS. Case Report: Simultaneous penetrating keratoplasty with autologous simple limbal epithelial transplantation as an alternative to keratoprosthesis. F1000Res 2023; 12:488. [PMID: 37455854 PMCID: PMC10349272 DOI: 10.12688/f1000research.133637.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction and importance: This case report highlights the multidisciplinary approach required to achieve successful anatomical and functional outcomes, in an eye with total limbal stem cell deficiency (LSCD) associated with underlying corneal scarring and thinning. Presentation of case: A 59-year-old gentleman had poor visual recovery in the right eye (RE) following accidental carbide blast, 1-year before presenting to us. The visual acuity was counting fingers and clinical examination revealed cicatricial entropion involving the upper eyelid, total LSCD, corneal scarring with a central descemetocele and cataract in the RE. Prior to ocular surface reconstruction, entropion correction was performed. Three months later, penetrating keratoplasty combined with cataract surgery and intraocular lens implantation (penetrating keratoplasty (PK) triple), with autologous simple limbal epithelial transplantation (SLET) was performed. The visual acuity was 20/100, 18 months after the surgery, with a clear well-epithelized corneal graft and stable ocular surface. Discussion: LSCD is caused by a decrease in the population and /or function of the limbal epithelial stem cells. Limbal stem cell transplantation (LSCT) is warranted in eyes with total LSCD. In eyes with coexisting corneal scarring, LSCT alone may be inadequate to restore the vision. These eyes require simultaneous or sequential lamellar or full-thickness corneal transplantation for visual rehabilitation. Though, the existing literature favors a sequential approach, where LSCT is performed first followed by corneal transplantation, under certain circumstances such as a thin underlying cornea like in our case, corneal transplantation may have to be combined with LSCT to achieve optimal outcomes. Conclusion: Combining autologous SLET with PK can be performed for visual rehabilitation in eyes with unilateral total LSCD and underlying corneal thinning. Corneal and limbal graft survival is prolonged if existing adnexal comorbidities are addressed before any surgical intervention is planned and adequate time interval is allowed for the surface inflammation to subside.
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Affiliation(s)
- Supriya Sharma
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S. Shanbhag
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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48
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Módis L, Lukács M, Makhoul S. [Corneal transplantation at the beginning of the 21th century]. Orv Hetil 2023; 164:1087-1093. [PMID: 37454331 DOI: 10.1556/650.2023.32822] [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: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 07/18/2023]
Abstract
Corneal transplantation (keratoplasty) is necessary when various disorders result in corneal opacities with severe visual loss that cannot be treated conservatively, or the regular structure and curvature of the cornea is distorted, and its function is lost. Among human transplantation, keratoplasty is the most successful surgical procedure. In recent decades, penetrating keratoplasties have been increasingly replaced by lamellar techniques, where only the abnormal layer of the cornea is transplanted. The anterior form is deep anterior lamellar keratoplasty (DALK), recommended mainly for keratoconus. The main forms of posterior lamellar keratoplasty are Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK). The indications are bullous keratopathy after cataract surgery with endothelial destruction and Fuchs endothelial dystrophy. Lamellar keratoplasty has several advantages over penetrating surgery. Postoperative visual acuity is better, wound healing, patient rehabilitation are faster and the course of any immune rejection is milder and can be better managed. Orv Hetil. 2023; 164(28): 1087-1093.
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Affiliation(s)
- László Módis
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szemészeti Tanszék Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Miklós Lukács
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szemészeti Tanszék Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Sára Makhoul
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szemészeti Tanszék Debrecen, Nagyerdei krt. 98., 4032 Magyarország
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49
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El Halabi M, Daas L, Flockerzi F, Seitz B. [Penetrating excimer laser keratoplasty after acute keratoglobus in osteogenesis imperfecta]. Ophthalmologie 2023; 120:771-775. [PMID: 36859561 DOI: 10.1007/s00347-023-01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Affiliation(s)
- M El Halabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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50
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Liu J, Guo X, Wei Z, Zhang Y, Zhang Z, Xu X, Liang Q. Infectious Keratitis After Keratorefractive Surgery: Update and Review of the Literature. Eye Contact Lens 2023; 49:275-282. [PMID: 37166228 PMCID: PMC10281179 DOI: 10.1097/icl.0000000000000996] [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] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To summarize the clinical manifestations, microbiological profile, treatment, and prognosis of corneal infections after different keratorefractive surgery. METHODS To obtain relevant studies, English-language databases, including PubMed, Ovid Embase, Web of Science, and CLNAHL, were searched from January 1979 to March 2022. The fundamentals of the literature, clinical characteristics, pathogens, and treatments were retrieved for each included article. RESULTS Eighty-four studies involving 306 infectious eyes were included in this review. Risk factors of potential infection included a history of blepharitis, contact lens usage, and contaminated surgical instruments. The mean onset time was 22.9±38.7 days (range: 1 day to 3 years). The most common organism isolated from infectious keratitis after keratorefractive surgery were Staphylococcus aureus , followed by Mycobacterium and coagulase-negative Staphylococcus . Most of the infections after refractive procedures were sensitive to medical treatment alone, and the ultimate best-corrected visual acuity after medical treatment was as follows: 20/20 or better in 82 cases (37.0%), 20/40 or better in 170 cases (76.5%), and worse than 20/40 in 52 cases (23.5%). Surgical interventions including flap lift, flap amputation, ring removal, and keratoplasty were performed in 120 eyes (44.5%). CONCLUSIONS Most infections after keratorefractive surgery occur within a week, whereas more than half of the cases after laser-assisted in situ keratomileusis happen after about a month. Gram-positive cocci and mycobacterium are the most common isolates. Infections after LASIK, intracorneal ring (ICR) implantation, and small incision lenticule extraction, which primarily occur between the cornea layers, require irrigation of the tunnels or pocket with antibiotics.
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Affiliation(s)
- Jiamin Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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