scholarly journals Indications And Outcomes Of Penetrating Keratoplasty at a Tertiary Hospital in Bangladesh

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
A S M Moin Uddin ◽  
Chandana Sultana ◽  
Md. A. Muntakim Shahid ◽  
Mohammed Rashed ◽  
Mohammad Shamsal Islam
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Rejection Rate ◽  
Corneal Dystrophy ◽  
Tertiary Hospital ◽  
Study Data ◽  
Bullous Keratopathy ◽  
Effective Treatment Option ◽  
Corneal Scarring

Purpose:  To find out the indications and outcomes of Penetrating Keratoplasty at a tertiary eye hospital in Dhaka, Bangladesh. Study Design:  This was a retrospective hospital based study. Place and Duration of Study:  Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh from July 2011 and July 2018. Methods:  In this study, data was collected from the records of patients, who came for treatment at the cornea unit. Pre-operative evaluation and post-operative follow-up record was analyzed. Patents’ demographic information, visual acuity, management, pre and post-operative complications, follow-up visits and outcomes were recorded. A technical research team headed by a senior consultant determined the content validity and their comments were incorporated in finalizing the research instruments. Results:  A total of 213 penetrating keratoplasties (PK) were performed during the study period. The main indications were keratoconus (8.28%), Corneal scarring (41.42%), Adherent leukomas (25.59%), corneal dystrophy (3.84) and bullous keratopathy (7.25%). Rejection rates at 8 years were 5.62%. Keratoconus showed the best graft survival (79%). The percentage of patients with post-transplant best-corrected visual acuity of 6/36 at 8 years was 52%. There was a statistically significant reduced rejection rate in males. Conclusion:  Penetrating Keratoplasty is an effective treatment option for improving visual outcomes for people with visual impairment. There are many co-factors involved with a quality outcome of patients with Penetrating Keratoplasty such as immunological rejection, microbial keratitis and patient level of awareness, which continue to limit the success. Key Words:  Penetrating, Keratoplasty, Bangladesh, Keratoconus, Corneal Dystrophy.

scholarly journals Femtosecond laser-assisted anterior lamellar keratoplasty (FSALK) versus microkeratome-assisted anterior lamellar keratoplasty (MALK) for the treatment of anterior corneal dystrophy.

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Radwan Almousa ◽  
Sheraz M Daya
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Visual Outcome ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Secondary Outcome ◽  
Clinical Recurrence ◽  
Corneal Scarring ◽  
Anterior Lamellar Keratoplasty

Purpose: To compare the visual outcome of femtosecond laser-assisted anterior keratoplasty (FSALK) and microkeratome-assisted anterior lamellar keratoplasty (MALK) in anterior corneal dystrophy.  Methods: retrospective comparative chart review of 7 eyes that underwent FSALK and 7 eyes that underwent MALK. The primary outcome was the visual outcome of both procedures. The secondary outcome was the recurrence of the corneal dystrophies.Results: Mean follow-up time was 30±14(7-51) months for the FSALK group and 127±28(80-127) months for the MALK group. In the FSALK group the preoperative best spectacle-corrected visual acuity (BSCVA) improved from 20/63 to 20/25 at 36 months. In the MALK group there was 1 eye with documented BSCVA over 36 months follow-up; it improved from 20/160 preoperatively to 20/32 at 36 months. Uncorrected visual acuity (UCVA) at 36 months improved from 20/100 preoperatively to 20/63 in the FSALK group and from 20/200 preoperatively to 20/63 in the MALK group. Five eyes with Reis-Bucklers showed a clinical recurrence at a mean of 142±13(125-152) months. Two eyes with granular dystrophy showed a clinical recurrence at 23 and 80 months of follow-up. One eye in the MALK group had epithelial ingrowth. One eye in the FSALK group with compromised ocular surface due to 2 previous penetrating keratoplasty, suffered bacterial keratitis that ended up with corneal scarring. Conclusion: Both procedures improve visual outcome for anterior corneal dystrophy. FSALK has theoretical advantages over MALK; however, larger prospective studies are needed to prove this.

scholarly journals Macular corneal dystrophy related to novel mutations of CHST6 in a Chinese family and clinical observation after penetrating keratoplasty

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dewei Li ◽  
Le Tian ◽  
Xiaochuan Wang ◽  
Min Chen
Keyword(s):  
Missense Mutation ◽  
Penetrating Keratoplasty ◽  
Vision Loss ◽  
Corneal Dystrophy ◽  
Postoperative Recurrence ◽  
Deletion Mutation ◽  
Chinese Family ◽  
Colloidal Iron ◽  
Macular Corneal Dystrophy

Abstract Background Macular corneal dystrophy (MCD) is a rare corneal stromal dystrophy with bilateral progressive vision loss. The pathogenic gene of MCD is carbohydrate sulfotransferase 6 (CHST6). Herein, we report a novel missense mutation and a rare exon deletion mutation in the CHST6 gene in a Chinese family with MCD. Methods Genomic DNA was extracted from the peripheral blood, and next generation sequencing was used to analyse the gene sequence. The pathogenic mutations were identified in all affected family members. The proband successively received binocular penetrating keratoplasty (PKP), and the corneas were examined by histopathology and colloidal iron staining to prove the diagnosis. A long-term follow-up was made to observe the changes after PKP. Results Genetic analysis demonstrated hemizygous mutations in the proband, including a novel c.520A>C (p.K174Q) missense mutation and a rarely reported exon 3 deletion mutation, which were co-segregated with the MCD phenotypes in the pedigree. The positive colloidal iron staining confirmed the diagnosis of MCD in the proband. However, the clinical phenotype and pathological manifestation of both eyes were different from each other because of complicated keratitis in the left eye. During the nine years of follow-up, visual acuity was improved significantly, and the cornea was transparent without rejection and postoperative recurrence in both eyes. Conclusions The novel hemizygous mutations were thought to contribute to the loss of CHST6 function, which induced typical clinical and pathological features of MCD. PKP was an effective treatment for MCD.

Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation

2003 ◽  
Vol 13 (2) ◽  
pp. 134-138 ◽  
Author(s):  
J.B. Jonas ◽  
R.M. Rank ◽  
W.M. Budde ◽  
G. Sauder
Keyword(s):  
Visual Acuity ◽  
Intraocular Lens ◽  
Penetrating Keratoplasty ◽  
Visual Outcome ◽  
Intraocular Lens Implantation ◽  
Postoperative Visual Acuity ◽  
Factors Influencing ◽  
Lens Implantation ◽  
Preoperative Visual Acuity

Purpose To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Methods This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity. Results Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. Conclusions The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

Topographically Guided Two-Step LASIK and Standard LASIK in the Correction of Refractive Errors after Penetrating Keratoplasty

2009 ◽  
Vol 19 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Leopoldo Spadea ◽  
Massimo Saviano ◽  
Angela Di Gregorio ◽  
Domenico Di Lodovico ◽  
Fabio De Sanctis
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Laser In Situ Keratomileusis ◽  
Refractive Errors ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Purpose To evaluate in a long-term period the effectiveness and safety of topographically guided two-step laser in situ keratomileusis (LASIK) and standard LASIK technique in the correction of refractive errors after successful penetrating keratoplasty (PKP) for keratoconus. Methods At least 2 years after PKP and 6 months after removal of all sutures, 15 eyes of 15 patients (Group 1; mean manifest refraction spherical equivalent (MRSE) −7.23 D ± 3.42 SD) were submitted to standard LASIK and 15 eyes of 15 patients (Group 2; mean MRSE −4.37 D ± 1.97 SD) to a topographically guided two-step LASIK procedure (first the flap and at least 2 weeks later the laser ablation). In all cases, a superior hinged corneal flap (160 μm/9.5 mm) was created. Results After a follow-up of 36 months, in Group 1 the mean uncorrected visual acuity (UCVA) was 0.51 logarithm of the minimum angle of resolution (logMAR) ± 0.41 SD and the mean best-corrected visual acuity (BCVA) was 0.03 logMAR ± 0.05 SD, with a mean MRSE of −1.57 D ± 2.65 SD. In Group 2, the mean UCVA was 0.28 logMAR ± 0.24 SD and the mean BCVA was 0.01 logMAR ± 0.03 SD, with a mean MRSE of −0.07 D ± 1.00 SD. In both groups, no complications were observed. Conclusions After a long follow-up period, both topographically guided two-step LASIK and standard LASIK could be considered effective and safe tools in the correction of refractive errors after successful PKP for keratoconus.

scholarly journals Postoperative therapy of penetrating keratoplasty in herpes simplex keratitis

2013 ◽  
Vol 154 (52) ◽  
pp. 2065-2070 ◽  
Author(s):  
Ildikó Süveges ◽  
Ágnes Füst ◽  
László Imre
Keyword(s):  
Visual Acuity ◽  
Mycophenolate Mofetil ◽  
Herpes Simplex ◽  
Graft Rejection ◽  
Penetrating Keratoplasty ◽  
Systemic Treatment ◽  
Herpes Simplex Infection ◽  
Viral Agent ◽  
Simplex Infection

Introduction: Keratitis due to herpes simplex infection is a common cause of corneal damage resulting in impaired vision. Aim: The aim of this study was to assess the outcome of penetrating keratoplasties in patients treated with systemic antiviral and immunosuppressive drugs. Method: The authors retrospectively analysed data of 12 patients who underwent penetrating keratoplasty. The average age at onset of the first keratitis preceding surgery was 18 years (between 5 and 40 years). The indication for surgery in 9 cases was to improve vision and in 3 patient to prevent corneal perforation. Nine patients were given both acyclovir and mycophenolate mofetil, as anti-viral agent and immunosuppressive treatment, respectively. Two patients were treated with anti-viral agent only while one patient received no systemic therapy. The average follow-up time was 53.1 months (between 16 and 84 months). Results: Of the 9 patients who underwent surgery for improving vision, 8 patients had transparent grafts during follow up without vascularization. All eight patients had been treated with acyclovir and mycophenolate mofetil. In one patient who had no systemic treatment recurrence and graft rejection was observed. Only one of the surgeries performed in acute stage of inflammation resulted in a properly healed transparent graft without recurrence and rejection. In this patient acyclivir and mycophenolate mofetil therapy had been given previously. In two cases the preventive – full or partial – systemic treatment had no effect. The visual acuity improved in all cases. In three patients visual acuity was influenced by some other factors as well. Conclusions: The systemic acyclovir and mycophenolat mofetil therapy is fairly successful in perforating keratoplasty due to herpes simplex infection. Acyclovir decreases the risk of recurrence, while mycophenolate mofetil may prevent graft rejection. The timing of surgery is decisive; it leads to better results when performed in a scarred, noninflammatory state. Orv. Hetil., 2013, 154(52), 2065–2070.

scholarly journals The Comparison of Visual Acuity After Congenital Cataract Surgery between Children ≤2 Years and >2-17 Years

2020 ◽  
Vol 3 (2) ◽  
pp. 70
Author(s):  
Adam Surya Romadhon ◽  
Joni Susanto ◽  
Rozalina Loebis
Keyword(s):  
Visual Acuity ◽  
Congenital Cataract ◽  
Cross Sectional Study ◽  
Study Data ◽  
Age Group ◽  
Cross Sectional ◽  
Group 2 ◽  
Congenital Surgery ◽  
Better Than

Introduction: Congenital cataract is turbidity occurs in eye lens that present at birth or immediately after. We aim to find out visual acuity after congenital surgery between children under 2 years old and 2-17 years old after following up 3, 6, 12 months.Methods: This was a cross-sectional study. Data were gathered from medical record of congenital cataract aged ≤2 years and >2-17 years including age of surgery, frequency of eyes, sex, laterality, and visual acuity of patients with best corrected visual acuity (BCVA). All data analyzed using Mann-Whitney test.Results: 41 children (67 affected eyes) in which 45 eyes that were operated at aged ≤2 years and 22 eyes were operated at aged >2-17 years. There was average difference of visual acuity between age group of ≤2 years and >2-17 years while following-up 3 months (1.60 ± 0.34 logMAR, 1.23 ± 0.67 logMAR, p = 0,003). Whereas in follow up 6 months (1.23 ± 0.47 logMAR, 1.15 ± 0.68 logMAR, p = 0,242) and 12 months (0.94 ± 0.47 logMAR, 0.96 ± 0.44 logMAR, p = 0,840), there were no difference significant average of visual acuity.Conclusion: Visual acuity after following-up 3 and 6 months in age group of >2-17 years were better than age group of ≤2 years, whereas after following-up 12 months in age group ≤2 years, it was obtained that visual acuity was better than age group of >2-17 years.

scholarly journals Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

2021 ◽  
Author(s):  
Jaya Kaushik ◽  
Ankita Singh ◽  
Rakesh Shetty ◽  
Jitendra Kumar Singh Parihar ◽  
Divya Kochhar ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Outcome ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Ocular Lens ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Lens Subluxation ◽  
Preoperative Visual Acuity ◽  
Endothelial Decompensation

Abstract Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

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 Individualized Corneal Patching for Treatment of Corneal Trauma Combined with Tissue Defects

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ting Zhang ◽  
Yanni Jia ◽  
Suxia Li ◽  
Weiyun Shi
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Foreign Bodies ◽  
Lamellar Keratoplasty ◽  
Corneal Perforation ◽  
Immune Rejection ◽  
Tissue Defects ◽  
Corneal Laceration ◽  
Corneal Trauma

Aim. To evaluate the efficacy of individualized corneal patching using a minimal graft for corneal trauma combined with tissue defects. Methods. Fifteen eyes (15 patients) were enrolled in this study, including 8 eyes with corneal perforation induced by removal of metal foreign bodies, 5 eyes with corneal laceration resulting from metal trauma, and 2 eyes with pencil injuries to the cornea. The size, shape, and depth of the tissue defects were assessed. For corneal perforation or irregular tissue defects, if the diameter or length was ≥3.0 mm, traditional penetrating keratoplasty (PK) or lamellar keratoplasty (LK) was adopted; if the diameter or length was ＜3.0 mm, a conical or irregular patch consistent with the defects was used. The visual acuity, corneal status, and postoperative complications were observed during the follow-up. Results. The diameter of corneal perforations was 1.0 mm in 2 eyes, 1.5 mm in 1 eye, 2.0 mm in 4 eyes, and 3.5 mm in 1 eye. During their PK procedures, a conical corneal graft was used in 7 eyes, while a traditional cylindrical graft was used in 1 eye. The other 7 eyes had corneal trauma combined with irregular tissue defects, which were full-thickness corneal defects in 5 eyes and lamellar defects in 2 eyes, all less than 3.0 mm in length. Thus, five eyes received PK, and 2 eyes received LK using an irregular wedge-shaped patch. The visual acuity increased greatly postoperatively, with mild corneal astigmatism. None of the patients developed immune rejection. Conclusion. Individualized corneal patching with a minimal graft can save corneal materials, relieve corneal scars, gain a good visual prognosis, and avoid immune rejection in the treatment of corneal trauma combined with tissue defects.

Ten-Year Survival of Optical Penetrating Keratoplasty and Risk Factors for Graft Failure in Thai Patients

2020 ◽  
Vol 103 (9) ◽  
pp. 883-890
Keyword(s):  
Risk Factors ◽  
Graft Survival ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Significant Risk ◽  
Visual Outcome ◽  
Successful Outcome ◽  
Bullous Keratopathy ◽  
One Year

Objective: To determine long-term graft survival and identify risk factors for secondary graft failure of optical penetrating keratoplasty (PK) in Thai patients. Materials and Methods: A Retrospective study of patients that underwent optical PK at Siriraj Hospital between January 2002 and December 2005 was done. Results: Of 131 eyes, primary graft failure was found in two eyes (1.5%) thus, 129 eyes were recruited. The three most common surgical indications were pseudophakic or aphakic bullous keratopathy (33.3%), corneal scars (post-trauma, post-infection) (20.9%), and regrafts (16.3%). Mean follow-up period was 93.2 months (1 to 183 months). One-year, 2-year, 5-year, and 10-year graft survival rates were 84.5%, 73.2%, 50.2%, and 24.7%, respectively. The leading cause of graft failure was irreversible allograft rejection (62.5%). Most (56.0%) of the first graft rejection happened within one year post-operatively. Graft survival was lower in eyes with regrafts, history of glaucoma, deep corneal vascularization, peripheral anterior synechiae, and occurrence of one or more rejection episodes. Multivariate regression analysis demonstrated that peripheral anterior synechiae and occurrence of one or more rejection episodes were the significant independent risk factors for graft failure. Considering patients with the clear grafts at the last follow-up, the final best-corrected visual acuity was 6/36 or better in 66.7% eyes and 6/18 or better in 31.6% eyes. Comparing to pre-operative vision, patients with the clear grafts at the last follow-up had improved visual outcome in most eyes (82.5%). Conclusion: Ten-year survival and visual outcome of optical PK showed successful outcome, however, the survival rate decreased over time. The significant risk factors for graft failure should be cautiously evaluated before surgery. Keywords: Corneal graft survival, Keratoplasty outcome, Optical penetrating keratoplasty

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