Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

Purpose. To analyze the indications and surgical procedures for repeat keratoplasty in eastern China from 2008 to 2019. Methods. This retrospective descriptive study included 418 eyes of 411 patients who underwent no less than 2 keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2019. Medical charts were reviewed. The primary indications for repeat keratoplasty, the reasons for regrafting, and the surgical techniques used in the treatment were collected and analyzed. Results. Among 418 eyes, 337 eyes (80.6%) had one repeat keratoplasty, and 81 eyes (19.4%) had multiple repeat keratoplasties (≥2 repeat keratoplasties). The median interval between the initial keratoplasty and the first repeat keratoplasty was 25 months, and that between two keratoplasties after the first repeat keratoplasty was 27.5 months. Infectious keratitis was the leading primary indication for single repeat keratoplasty (80 cases, 23.7%) and multiple repeat keratoplasties (19 cases, 23.5%). The second most common primary indication was bullous keratopathy for single repeat keratoplasty (49 eyes, 14.5%) and chemical injury for multiple repeat keratoplasties (14 eyes, 17.3%). The main reason for regrafting was allograft rejection (262 cases, 49.3%), followed by endothelial dysfunction (92 cases, 17.3%), and for vision improvement after tectonic keratoplasty (60 cases, 11.3%). Penetrating keratoplasty (PKP) was the major technique used in repeat keratoplasty (447 cases, 84.2%). However, Descemet stripping endothelial keratoplasty was more frequently used than PKP (72.4% vs. 27.6%, P < 0.001 ) in the treatment of failed endothelial keratoplasty. Conclusion. Infectious keratitis was still the leading cause of repeat keratoplasty in eastern China. Although PKP remains the major technique of repeat keratoplasty, the application of customized lamellar keratoplasty has greatly expanded in the last decade. Cautious selection of indications, surgical techniques, and timing for surgery is crucial for a good prognosis after repeat keratoplasty.

Download Full-text

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques

PLoS ONE ◽

10.1371/journal.pone.0249946 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249946

Author(s):

Noelia Sabater-Cruz ◽

Marc Figueras-Roca ◽

Lydia Padró-Pitarch ◽

Jaume Tort ◽

Ricardo P. Casaroli-Marano

Keyword(s):

Corneal Transplantation ◽

Surgical Techniques ◽

Annual Reports ◽

Bullous Keratopathy ◽

Corneal Transplant ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Eye Bank ◽

Increasing Trend ◽

Fuchs Endothelial Dystrophy

Purpose To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period. Methods Annual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed. Results A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067). Conclusion Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.

Download Full-text

Endothelial Keratoplasty: Yesterday and Today (literature review)

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2021-3-91-95 ◽

2021 ◽

pp. 91-95

Author(s):

M.M. Bikbov ◽

◽

L.R. Marvanova ◽

Keyword(s):

Literature Review ◽

Corneal Endothelium ◽

Corneal Transplantation ◽

Surgical Techniques ◽

Lamellar Keratoplasty ◽

Endothelial Keratoplasty ◽

Circular Section ◽

Posterior Lamellar Keratoplasty ◽

Donor Graft

The article presents the literature review on the history and development of endothelial keratoplasty, which is one of the options for corneal transplantation. It includes different surgical techniques (posterior lamellar keratoplasty, with removal of the a circular section of the Descemet's membrane, deep lamellar endothelial keratoplasty, posterior lamellar keratoplasty (automated), etc.) used for the treatment of patients with pathology of the corneal endothelium and is characterized by replacement of it with corneal back layers of the donor graft. Ophthalmic surgical practice has convincingly shown a significant advantage of modern methods of endothelial keratoplasty in comparison with classical penetrating keratoplasty, which is a long-term standard in the treatment of corneal pathology. Key word: endothelial keratoplasty, the pathology of the corneal endothelium, corneal transplantation, posterior lamellar keratoplasty, deep lamellar endothelial keratoplasty.

Download Full-text

Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve

Journal of Ophthalmology ◽

10.1155/2021/1819454 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Davide Borroni ◽

Carlos Rocha de Lossada ◽

Mohit Parekh ◽

Kunal Gadhvi ◽

Chiara Bonzano ◽

...

Keyword(s):

Learning Curve ◽

Corneal Transplantation ◽

Lamellar Keratoplasty ◽

Bullous Keratopathy ◽

Corneal Transplant ◽

Tissue Preparation ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Novice Surgeon

Lamellar keratoplasty is fast becoming the most popular form of corneal transplantation. The adoption of Descemet membrane endothelial keratoplasty (DMEK) in the management of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy is partly responsible for this shift in the paradigm of management of corneal pathology. The learning curve of DMEK, however, has been proven to be much steeper than previous endothelial keratoplasty procedures. To ease the procedure, experts have proposed multiple innovative techniques from tissue preparation to graft unfolding to aid the more novice surgeon. Here, we collate and share tips and tricks from our collective experiences to support the learning curve and outcomes in DMEK for both the novice and more experienced corneal transplant surgeons.

Download Full-text

Evolution of therapies for the corneal endothelium: past, present and future approaches

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316149 ◽

2020 ◽

pp. bjophthalmol-2020-316149

Author(s):

Hon Shing Ong ◽

Marcus Ang ◽

Jodhbir S Mehta

Keyword(s):

Corneal Endothelium ◽

Medical Science ◽

Corneal Transplantation ◽

Surgical Techniques ◽

Corneal Transplant ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Immunological Rejection ◽

Transplantation Procedures ◽

Rejection Rates

Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues – regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.

Download Full-text

Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital

International Journal of Ophthalmology ◽

10.18240/ijo.2022.01.19 ◽

2022 ◽

Vol 15 (1) ◽

pp. 128-134

Author(s):

Pham Ngoc Dong ◽

◽

Nguyen Thi Nga Duong ◽

Mai Thi Lien ◽

Angela C. Chen ◽

...

Keyword(s):

Risk Factor ◽

Ocular Trauma ◽

Corneal Transplantation ◽

Treatment Programs ◽

Lamellar Keratoplasty ◽

Infectious Keratitis ◽

Streptococcus Pneumonia ◽

Anterior Lamellar Keratoplasty ◽

Medical Histories ◽

Bacteria And Fungi

AIM: To report the etiologies, risk factors, treatments, and outcomes of infectious keratitis (IK) at a major Vietnamese eye hospital. METHODS: This is a retrospective review of all cases of IK at Vietnam National Eye Hospital (VNEH) in Hanoi, Vietnam. Medical histories, demographics, clinical features, microbiological results, and treatment outcomes were reviewed. RESULTS: IK was diagnosed in 1974 eyes of 1952 patients, with ocular trauma being the greatest risk factor for IK (34.2%), frequently resulting from an agriculture-related injury (53.3%). The mean duration between symptom onset and presentation to VNEH was 19.3±14.4d, and 98.7% of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH. Based on smear results of 1706 samples, the most common organisms identified were bacteria (n=1107, 64.9%) and fungi (n=1092, 64.0%), with identification of both bacteria and fungi in 614 (36.0%) eyes. Fifty-five of 374 bacterial cultures (14.7%) and 426 of 838 fungal cultures (50.8%) were positive, with the most commonly cultured pathogens being Pseudomonas aeruginosa, Streptococcus pneumonia, Fusarium spp., and Aspergillus spp. Corneal perforation and descemetocele developed in 391 (19.8%) and 93 (4.7%) eyes, respectively. Medical treatment was successful in resolving IK in 50.4% eyes, while 337 (17.1%) eyes underwent penetrating or anterior lamellar keratoplasty. Evisceration was performed in 7.1% of eyes, most commonly in the setting of fungal keratitis. CONCLUSION: Ocular trauma is a major risk factor for IK in Vietnam, which is diagnosed in almost 400 patients each year at VNEH. Given this, and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration, greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Download Full-text

Conjunctival flap revisited: is it only a temporary solution for difficult corneal diseases?

Health Renaissance ◽

10.3126/hren.v10i1.6006 ◽

1970 ◽

Vol 10 (1) ◽

pp. 40-45

Author(s):

MK Sharma ◽

K Dhakwa ◽

SKC Rai ◽

I Kanskai ◽

AM Bhari ◽

...

Keyword(s):

Herpes Simplex ◽

Corneal Transplantation ◽

Complete Healing ◽

Lamellar Keratoplasty ◽

Bullous Keratopathy ◽

Corneal Tissue ◽

Corneal Ulcers ◽

Conjunctival Flap ◽

Neurotrophic Keratitis ◽

Herpes Simplex Keratitis

Background: The conjunctival flap technique, first described by Gundersen in 1958 has not undergone any major modifications since then, except for some variations depending upon pathology and surgeons’ preferences. Objective: To show the importance of conjunctival (Gundersen) flap in different corneal diseases where keratoplasty is not possible immediately. Methods: Out of total 113 non-healing corneal ulcers of different etiologies, nine patients had undergone total conjunctival flap and the rest of the patients had partial conjunctival flap. Out of 104 partial flaps, 31 patients had bipedicle flap and 73 patients had pedicle conjunctival flap. Diagnoses for Gundersen flap surgery included chronic Non-healing infective keratitis with and without impending perforation(93) (fungal -30, no organisms on culture-42 and bacterial- 21), Neurotrophic keratitis(4),Herpes simplex keratitis(9),Bullous keratopathy(2),Infected nonhealing graft(2),presumed infective perforated keratitis(3)(anterior chamber formed after pad and bandage). Results: Eight flaps retracted due to ulcer necrosis out of which seven cases got perforated with complete healing of ulcer. One case had to be eviscerated due to panophthalmitis. One hundred five cases got cured. Conclusion: Conjunctival flap is the urgent and most reliable remedy (temporary or even permanent in some pathologies) for chronic nonresolving infective and presumed infective keratitis with or without impending perforation, neurotrophic keratitis, chronic herpes simplex keratitis, bullous keratopathy and persistent nonhealing epithelial defects where there are no immediate facilities for corneal transplantation. Conjunctival flap should be familiarized and emphasized as a primary and complementary surgical solution where penetrating keratoplasty or lamellar keratoplasty can’t be immediately performed due to lack of corneal tissue. DOI: http://dx.doi.org/10.3126/hren.v10i1.6006 HREN 2012; 10(1): 40-45

Download Full-text

Corneal Transplantation at an Ophthalmological Referral Center in Colombia: Indications and Techniques (2004-2011)

The Open Ophthalmology Journal ◽

10.2174/1874364101307010030 ◽

2013 ◽

Vol 7 (1) ◽

pp. 30-33 ◽

Cited By ~ 15

Author(s):

Virgilio Galvis ◽

Alejandro Tello ◽

Augusto José Gomez ◽

Carlos Mario Rangel ◽

Angélica María Prada ◽

...

Keyword(s):

Medical Records ◽

Geographical Area ◽

Corneal Transplantation ◽

Surgical Techniques ◽

Infectious Keratitis ◽

Common Indication ◽

Tertiary Referral Center ◽

Referral Center ◽

Corneal Transplants ◽

Second Period

Purpose: To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period. Methods: A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011. Results: During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK). Conclusions: Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.

Download Full-text

The ABCD of DALK

US Ophthalmic Review ◽

10.17925/usor.2017.10.02.93 ◽

2017 ◽

Vol 10 (02) ◽

pp. 93

Author(s):

Jod Mehta ◽

Keyword(s):

Corneal Transplantation ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Endothelial Keratoplasty ◽

Anterior Lamellar Keratoplasty

Corneal transplantation has changed rapidly over the last 20 years. In spite of the fact that endothelial keratoplasty has become the most dominant procedure, deep anterior lamellar keratoplasty (DALK), the anterior lamellar procedure, has not become so popular. There are several reasons for this, and this editorial will attempt to give some useful tips, that may not be found in papers or books, in the hope of helping people performing or starting off on their DALK journey.

Download Full-text

Senegalese Experience of Keratoplasties in Public and Private Practice (Aristide le Dantec Hospital and Clinique du Cap), Dakar

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr.03.03.05 ◽

2019 ◽

Vol 3 (3) ◽

Keyword(s):

Corneal Transplantation ◽

Primary Objective ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Small Scale ◽

Bullous Keratopathy ◽

Public And Private ◽

Anterior Lamellar Keratoplasty ◽

Corneal Transplants ◽

One Year

Introduction: The corneal surface is exposed to many external aggressions which can alter its transparency and regularity. Several keratoplasty techniques have been codified such as transfixing keratoplasty (KT) or deep anterior lamellar keratoplasty (KLAP) or rotational auto graft. Our work was carried out in Senegal, in a context where corneal transplants were not frequently performed. The aim of our study was to report results one year after a keratoplasty. Patients and Method: We conducted a retrospective study of patients who underwent prior transfixing or lamellar keratoplasty or rotational auto graft. It was carried out between the ophthalmological clinic Aristide Le Dantec hospital and the ophthalmological center of Clinique du Cap in Dakar, Senegal. It included all records of patients with postoperative follow-up greater than or equal to 1 year. The parameters studied were anamnestic data, preoperative clinical examination (indication of corneal transplantation) and postoperative results. Results: Twenty-six eyes of 22 patients were identified. The decrease in visual acuity evolved on average for 5 years. The operative indications were mainly represented by results of pillow type keratitis (30.76%), bullous keratopathy (23.08%), and keratoconus (23.08%). Surgery consisted of a transfixing keratoplasty in 84.61%, lamellar in 15.39% of the cases. Comments: The primary objective of keratoplasty is to restore the transparency, it can also help to remedy pain or improve the anatomical and aesthetic prognosis of the eyeball. The benefits of keratoplasty in our context of developing countries are the reduced cost and shorter waiting time vis-à-vis western countries. Conclusion: The results of our study are encouraging for surgery, still practiced on a small scale in our regions.

Download Full-text

Corneal transplantation for keratoconus

Scandinavian Journal of Optometry and Visual Science ◽

10.5384/sjovs.vol5i2p ◽

2013 ◽

Vol 6 (1) ◽

pp. 1-8

Author(s):

Sven Jonuscheit ◽

Michael J Doughty

Keyword(s):

Corneal Transplantation ◽

Surgical Techniques ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Corneal Transplant ◽

Eye Care ◽

Primary Eye Care ◽

Transplant Centre ◽

Anterior Lamellar Keratoplasty

This review discusses current techniques of corneal transplantation for moderate to advanced keratoconus. The aim of this article is to provide primary eye care practitioners with an overview of two current corneal transplantation modalities, namely penetrating and deep anterior lamellar keratoplasty. The main surgical techniques, the outcome of the procedures, common complications and the prognosis will be reviewed. Results from ongoing studies at a corneal transplant centre in Glasgow, Scotland will be discussed.

Download Full-text