PALT (Partial Allogeneic Limbal Transplantation): A New Surgical Technique For Limbal Stem Cell Deficiency

PurposeLimbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse.MethodsWe developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (PALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. ResultsAll 14 patients showed stable or increased visual acuity after the PALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average.ConclusionThe PALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The PALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.

Endothelial Keratoplasty: Yesterday and Today (literature review)

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.

Cross-linking new technologies application in the treatment of severe corneal pathologies of various etiologies in dogs and cats

The article presents the results of the clinical application of new technology — UV-corneal collagen cross-linking procedure, which we use in the complex therapy of severe corneal pathologies for dogs and cats: septic ulcers complicated by keratomalacia, keratectasias of various origins, endothelial-epithelial corneal dystrophies. The UV cross-linking method is often performed by us as a stage in the preparation of a donor graft during keratoplasty operations in dogs and cats. The effect of the cross-linking treatment procedure is achieved by photopolymerizing collagen fibers of corneal stroma under the combined action of photosensitizer (riboflavin solution) and ultraviolet radiation with a certain wavelength. After cross-linking, it is possible to achieve increase in the biomechanical and biochemical stability of the cornea, to observe dehydration and antimicrobial effects. The article contains information about the stages and results of several methods of UV-corneal collagen cross-linking, which we successfully use in clinical practice in dogs and cats: A-CXL method, PACK-CXL, M-CXL, method of cross-linking modification of donor heterologous graft as a stage in performing keratoplasty surgery to recipient. Based on our clinical results, we can conclude that corneal cross-linking in dogs and cats has a high therapeutic potential and is a promising method for treating severe keratopathies in cases of weak effectiveness of traditional drug therapy regimens.

Laparoscopic Orthotopic Kidney Transplantation in Swine: A Novel Vascular Prop Device for Venous Anastomoses

Objective: To investigate the safety and efficacy of a vascular prop device for laparoscopic orthotopic kidney transplantation (LOKT) in swine.Material and Methods: Twenty swine were randomly divided into two groups. A vascular prop device was used in the observation (VP) group, and the vein beltization technique was used in the control (VB) group. The right kidney, as a donor graft, was laparoscopically transplanted to the location of the left kidney after a left nephrectomy. Data on the operative time, venous anastomotic time, vein stenosis, etc., and the survival of the swine in the two groups were recorded.Results: The mean transplant operative time, the mean cold ischemia time, and the venous anastomotic times in the VP group were significantly shorter than those in the VB group. Seven swine in the VP group and three swine in the VB group survived for 7 days. Autopsy results showed the occurrence of one artery stenosis and one vein stenosis in the VP group and one artery stenosis and five vein stenoses in the VB group. The median survival time was 6.25 days for the swine in the VP group and 4.40 days for those in the VB group.Conclusions: The vascular prop device is safe and feasible for LOKT in swine and may accelerate venous anastomosis and ensure the quality of venous anastomotic stoma.

The Utility of Extended Criteria Donor Livers in High Acuity Liver Transplant Recipients

Background Although the use of extended criteria donor (ECD) liver allografts has gained momentum as a potential method by which to expand the donor pool, their use largely remains relegated to low acuity liver transplant (LT) recipients. Thus, we sought to examine whether such grafts also have utility in high acuity (Model for End-Stage Liver Disease [MELD] ≥ 35) recipients. Study Design Extended criteria donors were defined as donor age > 60 years, hepatitis C virus positive donor, split livers, livers with cold ischemia time > 12 h, donor after cardiac death livers, or having macrosteatosis > 30%. Outcomes were compared between standard liver (SL) and ECD grafts in recipients with MELD ≥ 35. Results Of 225 patients, 46 (20.4%) received an ECD liver and 179 (79.6%) received a SL. Extended criteria donor graft recipients had significantly higher levels of post-LT maximal transaminases and rate of early allograft dysfunction. Nonetheless, high acuity ECD graft recipients had similar short- and long-term patient survival compared to SL recipients, with 1-,3-, and 5-year survivals of 86.9%, 82.3%, 79.3% and 86.9%, 80.5%, and 75.4%, respectively ( P = .674). There were also no significant differences in graft survival or rejection-free survival between the 2 groups. Conclusion The lack of inferior patient/graft survival among high acuity ECD graft recipients suggests that ECD livers present a viable method by which to expand the donor pool for this group of patients.

Fusarium infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during regular infusion of tocilizumab: a case report

Background Filamentous fungi are ubiquitous in plants, water, and soil. The predominant fungi that infect the human cornea include Fusarium and Aspergillus species. The onset of fungal endophthalmitis is indolent, and typically takes weeks to months to develop after corneal infection. We report a case of Fusarium infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during intravenous tocilizumab therapy. Case presentation A 65-year-old female patient was referred to our department due to pain and decreased vision in her left eye. Slit-lamp examination showed a white focus on the upper peripheral cornea, hypopyon, anterior chamber fibrin formation, marked ciliary hyperemia, and whole corneal epithelial defects. As the corneal scraping smear was positive for filamentous fungi and Fusarium species were detected by aqueous humor polymerase chain reaction, anti-fungal therapy was started. Although the initial response to anti-fungal therapy was good, we observed corneal infiltration, worsening hypopyon, and vitreous opacity after tocilizumab infusion. Given that the infection continued to progress despite conservative therapy, we performed penetrating keratoplasty combined with vitrectomy. After removal of the white focus beneath the intraocular lens, a temporary corneal prosthesis was mounted and the dense vitreous opacity was removed. Finally, a frozen donor graft was sutured in place. The corneal infiltration, hypopyon, and vitreous opacity all disappeared after the operation. Conclusion The rapid progression of Fusarium keratitis to endophthalmitis in a patient who was receiving a regular infusion of tocilizumab demonstrates that ocular condition should be closely monitored during systemic tocilizumab administration due to increased risk of infection.

Nonvascularized autologous fibular strut graft can be an option for treatment of segmental bone loss in comminuted femoral shaft fracture

We present the case of a patient who suffered a comminuted femoral shaft fracture. The patient was a 20 years-old male following a sustained RTA and presented at our hospital after about 6 weeks after the incidence. Initially he was treated with skeletal traction with surgical toileting and debridement; and later on external fixator with dressing several times. Open reduction and internal fixation was performed with the use of a non-vascularized autologous fibular strut graft as an augmentation technique in conjunction with dynamic plating. Bony union occurred at 24 weeks. Clinically patient had stable, painless extremity, and resumed active use of the involved extremity without protective device after 2 year after femur fixation. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free non-vascularized autogenous fibular strut bone graft as an option to bridge segmental bone loss in comminuted femoral shaft fracture. This is a relatively simple, not expensive procedure.