Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

Systematic review and meta-analysis of femtosecond laser–enabled keratoplasty versus conventional penetrating keratoplasty

2020 ◽  
pp. 112067212091448
Author(s):  
Yang Liu ◽  
Xiaojun Li ◽  
Wenjie Li ◽  
Xudong Jiu ◽  
Mannan Tian
Keyword(s):  
Femtosecond Laser ◽  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Mean Difference ◽  
Spherical Equivalent ◽  
Corrected Visual Acuity ◽  
Standard Mean Difference ◽  
Topographic Astigmatism ◽  
Best Corrected Visual Acuity

Purpose: The aim of this meta-analysis is to compare femtosecond laser–enabled keratoplasty with conventional penetrating keratoplasty regarding postoperative astigmatism, visual functions, graft rejection, graft failure, and complications. Methods: Eligible studies were retrieved from five mainstream electronic databases, including PubMed, Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrial.gov. Postoperative topographic astigmatism was set as the primary outcome, and best-corrected visual acuity, spherical equivalent, endothelial cell density, graft rejection, graft failure, and complications were chosen as the secondary outcomes. Standard mean difference and risk ratio were the size effects for continuous data and binomial data, respectively. The data were pooled through either the random-effects model or the fixed-effects model based on data heterogeneity. Moreover, subgroup analyses were conducted when the heterogeneity occurred distinctly (I2 > 50%). Results: A total of seven comparative studies were included. The pooled standard mean difference (−0.32, 95% confidence interval: −0.74 to 0.10) showed that femtosecond laser–enabled keratoplasty was not superior over conventional penetrating keratoplasty to decrease postoperative topographic astigmatism (p = 0.14). However, best-corrected visual acuity after femtosecond laser–enabled keratoplasty was significantly better than that after conventional penetrating keratoplasty (p = 0.00, standard mean difference: −0.23, 95% confidence interval: −0.37 to −0.10). Furthermore, endothelial cell density after femtosecond laser–enabled keratoplasty was preserved significantly better (p = 0.03, standard mean difference: 0.63, 95% confidence interval: 0.07–1.20). Moreover, spherical equivalent, graft rejection, graft failure, and complications represented no distinct differences between femtosecond laser–enabled keratoplasty and conventional penetrating keratoplasty (p > 0.05). Conclusion: Femtosecond laser–enabled keratoplasty may not be superior over conventional penetrating keratoplasty in decreasing postoperative topographic astigmatism, but might have advantages to achieve best-corrected visual acuity and endothelial cell density preservation. In addition, the two techniques seem to be comparable regarding spherical equivalent, graft rejection/failure, and complications.

scholarly journals Non-Descemet Stripping Automated Endothelial Keratoplasty for Bullous Keratopathy in Buphthalmic Eye

2016 ◽  
Vol 7 (2) ◽  
pp. 279-284 ◽  
Author(s):  
Koji Hirano ◽  
Shu Kachi ◽  
Masako Matsuura ◽  
Kazuhide Kawase ◽  
Won Sun Park
Keyword(s):  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Crystalline Lens ◽  
Bullous Keratopathy ◽  
Topical Steroids ◽  
Endothelial Keratoplasty ◽  
Corrected Visual Acuity ◽  
The Right ◽  
Phakic Eyes

Purpose: To report the 2-year follow-up findings in a patient with buphthalmic bullous keratopathy (BK) who was successfully treated with non-Descemet stripping automated endothelial keratoplasty (nDSAEK). Methods: A 39-year-old man had an endothelial graft of 8.0 mm diameter placed uneventfully using the nDSAEK method for phakic BK with buphthalmos of the left eye. He had had a penetrating keratoplasty in the right eye due to aphakic BK 5 years earlier, which, however, resulted in the invasion of blood vessels and graft failure. Since the left eye was phakic, Descemetorhexis was not performed because the instruments might touch the crystalline lens. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at 2 weeks, and at 1, 3, 6, 12, 18 and 24 months after nDSAEK. Results: Twenty-four months after nDSAEK, his left cornea and lens remained clear, and the decimal BCVA was 0.8. However, the ECD of the graft had decreased from 2,274 cells/mm2 before nDSAEK to 539 cells/mm2 24 months after the surgery, and the rate of decrease appeared to be slightly faster than that of former reports. An IOP of >30 mm Hg was recorded at around 2 months after the surgery, but was well controlled by tapering the topical steroids and the addition of topical brinzolamide and latanoprost. Conclusion: Our findings show that nDSAEK can be successfully used to treat buphthalmic BK. We recommend that nDSAEK be considered especially in phakic eyes with a smooth posterior surface around the pupillary area.

scholarly journals Graft Rejection Rate and Graft Failure Rate of Penetrating Keratoplasty (PKP) vs Lamellar Procedures: A Systematic Review

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0119934 ◽  
Author(s):  
Zarique Z. Akanda ◽  
Abdul Naeem ◽  
Elizabeth Russell ◽  
Jillian Belrose ◽  
Francie F. Si ◽  
...  
Keyword(s):  
Systematic Review ◽  
Failure Rate ◽  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Rejection Rate

Graft Rejection and Graft Failure After Anterior Lamellar Versus Penetrating Keratoplasty

2011 ◽  
Vol 152 (6) ◽  
pp. 1081-1082
Author(s):  
Balasubramanian Ramasamy ◽  
Adrian Tey ◽  
Stephen B. Kaye
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty

Graft Rejection and Graft Failure After Anterior Lamellar Versus Penetrating Keratoplasty

2011 ◽  
Vol 151 (6) ◽  
pp. 1024-1029.e1 ◽  
Author(s):  
Vincent M. Borderie ◽  
Emmanuel Guilbert ◽  
Olivier Touzeau ◽  
Laurent Laroche
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty

scholarly journals A case of eczema treated with homoeopathic medicine

2020 ◽  
Vol 3 ◽  
pp. 20-23
Author(s):  
Baljeet Singh Meena ◽  
Arun Kumar ◽  
Navita Bagdi
Keyword(s):  
Case Report ◽  
Male Patient ◽  
Large Scale ◽  
Conventional Medicine ◽  
Topical Steroids ◽  
Evidence Based ◽  
Positive Role ◽  
The Face ◽  
Study Designs

Eczema is a superficial inflammation of the skin. In conventional medicine, it is treated with emollients and topical steroids. We present the case of a 44-year-old male patient with eczema over the face, neck, chest and hands, who was treated with the homoeopathic medicines sulphur and graphites without the aid of emollients and steroids. It is clearly apparent from this evidence-based case report that homoeopathy has a positive role in the treatment of eczema. This finding can provide the basis for conducting large-scale studies with different study designs regarding the treatment of eczema with homoeopathy.

Public Investment Criteria: Benefit-Cost Analysis for Planned Economic Growth by Stephen A. Marglin. London: George Allen & Unwin Ltd., 1967. pp.103. 22s. 6d.********** Investments for Capacity Expansion: Size, Location and Time-Phasing edited by Alan S. Manne. London: George Allen & Unwin Ltd., 1967. pp.239. 45s.Investments for Capacity Expansion: Size, Location and Time-Phasing edited by Alan S. Manne. London: George Allen & Unwin Ltd., 1967. pp.239. 45s.

1967 ◽  
Vol 7 (3) ◽  
pp. 416-420
Author(s):  
Arthur MacEwan
Keyword(s):  
Cost Benefit Analysis ◽  
Public Investment ◽  
Cost Benefit ◽  
Capacity Expansion ◽  
Point Of View ◽  
Systematic Analysis ◽  
Benefit Cost Analysis ◽  
The Government ◽  
The Many ◽  
Benefit Cost

These books are numbers 4 and 5, respectively, in the series "Studies in the Economic Development of India". The two books are interesting complements to one another, both being concerned with the analysis of projects within national plan formulation. However, they treat different sorts of problems and do so on very different levels. Marglin's Public Investment Criteria is a short treatise on the problems of cost-benefit analysis in an Indian type economy, i.e., a mixed economy in which the government accepts a large planning responsibility. The book, which is wholely theoretical, explains the many criteria needed for evaluation of projects. The work is aimed at beginning students and government officials with some training in economics. It is a clear and interesting "introduction to the special branch of economics that concerns itself with systematic analysis of investment alternatives from the point of view of a government".

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

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