scholarly journals Recurrent Keratoconus

2013 ◽  
Vol 2 (2) ◽  
pp. 65-68
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Options ◽  
Corneal Transplantation ◽  
Wound Dehiscence ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Time To Recurrence ◽  
Anterior Lamellar Keratoplasty ◽  
Corneal Thinning ◽  
Corneal Disorder

Abstract Keratoconus is an ectatic corneal disorder characterized by progressive corneal thinning and protrusion. Keratoconus recurrence after corneal transplantation although rare is present and has been confirmed histologically. Host, donor, genetic, mechanical and environmental factors have been proposed as predisposing factors to initiate keratoconus recurrence. The time-to-recurrence post-deep anterior lamellar keratoplasty seems to occur earlier than after penetrating keratoplasty. Wound dehiscence and high astigmatism post-transplant are plausible differential diagnosis for this entity. The treatment options are similar to primary keratoconus. Since, the era of collagen corneal cross-linking, early diagnosis is desirable as it could halt the progression of recurrent keratoconus. How to cite this article Barbara R, Barbara A. Recurrent Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):65-68.

Toward Safer Treatment Options for Advanced Keratoconus

2015 ◽  
Vol 8 (1) ◽  
pp. 33
Author(s):  
Jack Parker ◽  
Ricarda M Konder ◽  
Korine van Dijk ◽  
Gerrit RJ Melles ◽  
◽  
...  
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Options ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Visual Rehabilitation ◽  
Corneal Disease ◽  
Anterior Lamellar Keratoplasty ◽  
New Treatment ◽  
Irregular Astigmatism ◽  
Corneal Thinning

Keratoconus is a bilateral and progressive corneal disease characterized by a significant increase in irregular astigmatism and corneal thinning. Numerous treatments—including penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), ultraviolet-crosslinking (UV-CXL), and intracorneal ring segments—are available for halting progression and/or obtaining (partial) visual rehabilitation. Recently, midstromal Bowman layer transplantation has been introduced as a new treatment option for advanced keratoconus. This technique has shown significant promise in halting disease progression and postponing riskier procedures such as PK or DALK.

scholarly journals Glaucoma and Corneal Transplant Procedures

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Ammar M. Al-Mahmood ◽  
Samar A. Al-Swailem ◽  
Deepak P. Edward
Keyword(s):  
Intraocular Pressure ◽  
Treatment Options ◽  
Corneal Transplantation ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Anterior Lamellar Keratoplasty ◽  
Intraocular Pressure Elevation ◽  
High Incidence ◽  
Number Of Treatment

Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients.

scholarly journals Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

2019 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu
Keyword(s):  
Optical Coherence Tomography ◽  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Optical Coherence ◽  
Visual Outcomes ◽  
Total Prevalence ◽  
Anterior Lamellar Keratoplasty

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the correlations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Correlations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)] were evaluated for 45 patients (one eye each). Results: 22 post-PK and 23 post-DALK keratoconic patients were enrolled. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased by 6.851, 5.428 and 5.164 times for every 1% increase in: F (step) [b=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [b=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [b=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased by 0.031 times for every 1-μm increment of |Tg-Th| [b=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased by 0.001 times for every 1-μm increment of both GHT [b=0.001; 95% CI=0-0.002; P=0.030]. and Tg [b=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased by 0.017 times for 1-μm increment of Sm [b=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.

scholarly journals Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

2020 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu
Keyword(s):  
Optical Coherence Tomography ◽  
Penetrating Keratoplasty ◽  
Linear Regression Analysis ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Optical Coherence ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg), junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)]. Results: We enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [β=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [β=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [β=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased averagely by 0.31 diopter per 10-μm increment in |Tg-Th| [β=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-μm increment in both GHT [β=0.001; 95% CI=0-0.002; P=0.030]. and Tg [β=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased on average by 0.17 diopter per 10-μm increment in Sm [β=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.

Keratoconus Treatment Toolbox: An Update

2020 ◽  
Author(s):  
Vatookarn Roongpoovapatr ◽  
Mohamed Abou Shousha ◽  
Puwat Charukamnoetkanok
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Options ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Visual Rehabilitation ◽  
Intrastromal Corneal Ring ◽  
Anterior Lamellar Keratoplasty ◽  
Corneal Scar ◽  
Ring Segment ◽  
Collagen Cross Linking

Keratoconus is a bilateral, asymmetric, progressive disease of the cornea which can lead to visual impairment and blindness as irregular astigmatism increases and corneal scar occurs. Currently, many methods are available for a treatment of keratoconus. The treatment can help enhance visual rehabilitation and prevent progression in keratoconus patients. The treatment options included non-surgical and surgical managements. This review offers a summary of the current and emerging treatment options for keratoconus- eyeglasses, contact lens, corneal collagen cross-linking (CXL), CXL Plus, intrastromal corneal ring segment (ICRS), Corneal Allogenic Intrastromal Ring Segments (CAIRS), Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Bowman layer transplantation (BL transplantation) and gene therapy.

Corneal transplantation trends in France from 2004 to 2015: A 12-year review

2018 ◽  
Vol 28 (5) ◽  
pp. 535-540 ◽  
Author(s):  
Guillaume Bigan ◽  
Marc Puyraveau ◽  
Maher Saleh ◽  
Philippe Gain ◽  
Isabelle Martinache ◽  
...  
Keyword(s):  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Corneal Dystrophy ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Endothelial Keratoplasty ◽  
Surgical Indications ◽  
Anterior Lamellar Keratoplasty ◽  
Important Shift

Purpose: The aim of this study was to report the 12-year longitudinal trends in indication and corneal transplantation techniques in France from 2004 to 2015. Results: The records of all corneal transplantations performed from 2004 to 2015 in France were retrospectively reviewed. The patient indications and types of transplant performed were analyzed. A total of 46,658 corneal transplantations were performed between 2004 and 2015, with 34,187 (73.3%) penetrating keratoplasty and 10,452 (22.4%) lamellar keratoplasty. The leading surgical indications were secondary endothelial failure (24.3%), keratoconus (18.8%), regraft (13.5%), and Fuchs endothelial corneal dystrophy (15.1%). Endothelial keratoplasty became the preferred technique for endothelial diseases and deep anterior lamellar keratoplasty the preferred technique for keratoconus, surpassing penetrating keratoplasty in 2013. Conclusion: Secondary endothelial failure is the top indication for performing a keratoplasty over the 12-year period. There was a shift from penetrating keratoplasty to endothelial keratoplasty performed for Fuchs endothelial corneal dystrophy and secondary endothelial failure, and to deep anterior lamellar keratoplasty, performed for keratoconus. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.

scholarly journals Traumatic Wound Dehiscence after Keratoplasty: Characteristics, Risk Factors, and Visual Outcome

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mohamed Bahgat Goweida ◽  
Hany Ahmed Helaly ◽  
Alaa Atef Ghaith
Keyword(s):  
Risk Factors ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Wound Dehiscence ◽  
Visual Outcome ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Traumatic Wound

Purpose.The study aimed at evaluating the patients’ characteristics, risk factors, complications, and visual outcome of traumatic wound dehiscence after keratoplasty.Patients and Methods. A retrospective case series that included 20 eyes of 20 patients who had undergone a previous keratoplasty procedure followed by traumatic wound dehiscence. Records of the selected patients were reviewed. The mean duration of follow-up after repair was 21 months. Included patients were recalled for the final follow-up visit.Results.The procedure of corneal transplantation was penetrating (PKP) in 16 eyes and deep anterior lamellar keratoplasty (DALK) in 4 eyes. The associated anterior segment injuries included iris prolapse in 17 eyes and lens extrusion in 12 eyes. The associated posterior segment injuries included vitreous hemorrhage in 11 eyes and retinal detachment in 4 eyes. The final BSCVA was 0.1 or better in 5 cases (25 %) and was better than hand motions (HM) to less than 0.1 in 7 cases (35 %).Conclusion.Traumatic wound dehiscence following keratoplasty results in poor visual outcome. Cases following DALK may have less wound extent and better final visual outcome. The dehiscence seems most likely to occur during the first year.

scholarly journals Malapposition of Graft-host Interface after Penetrating Keratoplasty (PK) and Deep Anterior lamellar Keratoplasty (DALK): an optical coherence tomography study

2019 ◽  
Author(s):  
Yujin Zhao ◽  
Hong Zhuang ◽  
Jiaxu Hong ◽  
Lijia Tian ◽  
Jianjiang Xu
Keyword(s):  
Optical Coherence Tomography ◽  
Penetrating Keratoplasty ◽  
Linear Regression Analysis ◽  
Corneal Transplantation ◽  
Anterior Segment ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Optical Coherence ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty

Abstract Backgroud: Previous studies of internal graft-host malappositions have not dealt with the precise ways in which each malapposition affected post-penetrating keratoplasty (post-PK) visual outcomes. In this study, we reviewed our post-PK and post-deep anterior lamellar keratoplasty (post-DALK) keratoconic patients and used anterior segment optical coherence tomography (AS-OCT) to evaluate the associations between graft-host interface (GHI) characteristics and visual outcomes. Methods: Novel GHI metrics included: mean graft-host touch (GHT), total prevalence of malapposition proportion (Pm), frequency of apposition (F), size of malapposition (Sm), junctional graft thickness (Tg),junctional host thickness (Th) and the absolute value of difference between Tg and Th (|Tg-Th|). We connected the external and internal junction points of GHI (GHT) and drew a straight line through the central point, perpendicular to both sides of the cornea. Tg and Th were the thicknesses at cross-points 1 mm away from the meeting point on the external side of the graft and host, respectively. Linear regression analysis was used to describe associations between GHI metrics and postsurgical visual outcomes [ logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA), spherical equivalent diopter (SE), diopter of spherical power (DS), diopter of cylindrical power (DC) and keratometric astigmatism (Astig value)]. Results: We enrolled 22 post-PK and 23 post-DALK keratoconic patients. Compared with the regular-apposition results, GHT was decreased in step and gape patterns, and increased in hill and tag patterns. SE increased averagely by 6.851, 5.428 and 5.164 diopter per 1% increase in: F (step) [β=6.851; 95% Confidence interval (CI)=2.975-10.727; P=0.001]; F (graft step) [β=5.428; 95% CI=1.685-9.171; P=0.005]; and Pm [β=5.164; 95%CI=0.913-9.146; P=0.018], respectively. SE increased averagely by 0.31 diopter per 10-μm increment in |Tg-Th| [β=0.031; 95% CI=0.009-0.054; P=0.007]. LogMAR BCVA increased (on average) by 0.01 per 10-μm increment in both GHT [β=0.001; 95% CI=0-0.002; P=0.030]. and Tg [β=0.001; 95% CI=0.001-0.002; P=0.001]. Astig value increased on average by 0.17 diopter per 10-μm increment in Sm [β=0.017; 95% CI=0-0.033; P=0.047]. Conclusion: This investigation of GHI characteristics suggests explanations for varied ametropia in keratoconic eyes and has potential significance as a reference for promoting pre-surgical planning and technology for corneal transplantation.

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