scholarly journals Corneal transplantation for keratoconus

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. 

Corneal graft surgery: A monocentric long-term analysis

2020 ◽  
pp. 112067212094759
Author(s):  
Andrea Montesel ◽  
Jorge L Alió del Barrio ◽  
Pilar Yébana Rubio ◽  
Jorge L Alió
Keyword(s):  
Survival Rates ◽  
Surgical Techniques ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Inclusion Criteria ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty ◽  
Immunological Rejection ◽  
Clinical Records

Purpose: To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center. Setting: Vissum Instituto Oftalmológico, Alicante, Spain. Methods: A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes. Results: A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques. Conclusion: Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

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.

Stability of visual outcome between 2 and 5 years following corneal transplantation in the UK

2017 ◽  
Vol 102 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Sing-Pey Chow ◽  
Cathy L Hopkinson ◽  
Derek M Tole ◽  
Mark N Jones ◽  
Stuart D Cook ◽  
...  
Keyword(s):  
Corneal Transplantation ◽  
Visual Outcome ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty ◽  
Postoperative Time ◽  
The Stability ◽  
The Uk

Background and AimsMany studies of corneal transplantation focus on graft failure or rejection as endpoints, or report visual outcomes at one postoperative time point. We aimed to study the stability of visual outcomes between 2 and 5 years following corneal transplantation.MethodsAll patients with keratoconus (868) or Fuchs endothelial dystrophy (FED) (569) receiving their first corneal transplant for visual purposes in the UK between January 2003 and December 2009 were included. The probability of visual improvement or deterioration (gain or loss of ≥2 Snellen lines, respectively) between 2 and 5 years after keratoplasty was modelled by multivariable logistic regression.ResultsThe majority of keratoconus patients with a penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty maintained their visual acuity (651/868; 75%) while 15% (133/868) improved and 10% (84/868) deteriorated. Similarly, most patients with FED who received a PK maintained their vision (395/569; 70%) while 18% (105/569) improved and 12% (68/569) deteriorated.

scholarly journals Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

2020 ◽  
Vol 12 ◽  
pp. 251584142091301
Author(s):  
Sepehr Feizi ◽  
Amir A Azari
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Neovascularization ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Vernal Keratoconjunctivitis ◽  
Full Thickness ◽  
Appropriate Treatment ◽  
Anterior Lamellar Keratoplasty

The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor–recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.

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.

scholarly journals The ABCD of DALK

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.

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

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.

scholarly journals Deep Anterior Lamellar Keratoplasty for Ectatic Disease

2013 ◽  
Vol 2 (1) ◽  
pp. 20-27
Author(s):  
Isaac Ramos ◽  
Paulo Schor ◽  
Allan Luz ◽  
Luciene Babosa ◽  
Bruno Machado Fontes
Keyword(s):  
Survival Rate ◽  
Penetrating Keratoplasty ◽  
Surgical Techniques ◽  
Cost Benefit ◽  
Viable Alternative ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Cause Of Failure ◽  
Visual Results

ABSTRACT Recently, deep anterior lamellar keratoplasty (DALK) has received attention for patients with ectatic diseases not affecting the endothelium. However, it was not always so. For years, DALK was overlooked due to the difficulty in achieving good visual results, which were considered weak in comparison with the results of penetrating keratoplasty (PK). DALK was proposed to retain a patient's healthy endothelium; thereby avoiding some possible complications of PK. Preservation of the endothelium contributes to prolonged survival of the button and thus overcomes a major cause of failure after PK. DALK is now accepted as a viable alternative to PK. With advances in surgical techniques, instruments, and imaging technologies, visual results obtained with lamellar keratoplasty are equivalent to visual outcomes with PK, in addition to providing a transplant cost benefit owing to a better transplantation survival rate. How to cite this article Luz A, Babosa L, Fontes BM, Ramos I, Schor P, Ambrósio R Jr. Deep Anterior Lamellar Keratoplasty for Ectatic Disease. Int J Kerat Ect Cor Dis 2013;2(1):20-27.

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.

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