Distribution by Scientific Domains

Kinds of Keratoplasty

  • endothelial keratoplasty
  • penetrating keratoplasty

  • Selected Abstracts

    The taming of the shrew or corneal transplantation: past, present and future

    Keratoplasty has definitely its paradoxes. It has been the first successful transplantation in man and is with approx. 100. 000 grafts/year easily the most frequent allograft in human medicine. At the same time it is still the least understood form of transplantation in respect to its biology. It is both, the most successfull as well as probably the most underestimated procedure regarding its risks in clinical transplantation. Indeed, the common assumtion, that corneal transplantation is a safe procedure with good prognosis may have hindered more intensive effort of research in this field. This lecture aims to highlight significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated individuals involved in the development of keratoplasty. There are still limitations to corneal transplantation, and corneal allograft rejection still poses the greatest challenge to the modern corneal surgeon. Therefore, particular emphasis will be paid to recent efforts and developments to overcome this challenge. [source]

    Adequate HLA Matching in Keratoplasty

    Niels Ehlers
    No abstract is available for this article. [source]

    1313: Lamellar and penetrating keratoplasties


    2145: Descemet´s membrane detachment 16 years after PK and 10 months after phaco

    Purpose The purpose of this paper is to present an unusual case of DMD and analyze this complication Methods A 57-year-old woman, who had bilateral keratoconus, underwent three penetrating keratoplasties (PK) on her RE in 1981, 1993 and 1995 resulting in ptisis bulbi. In her LE she underwent two PK (1981, 1994) follow by arcuate incisions (1995) and an uneventful phacoemulsification in 2007. 10 months after cataract surgery, she begun with blurred vision, the BCVA was 20/400 and was seen by 3 ophthalmologists who made the diagnosis of endothelial failure and suggested a new PK or a DSAEK. We performed an Optical Coherence Tomography, diagnosing a complete Descemet´s membrane detachment (DMD). An intracameral gas injection of C3F8 at 16% was performed in the operating room, and the patient was instructed to maintain a supine position. After 24 hours VA improved to 20/80 and after 72 hours 20/30 UCVA. A small bubble was present in the anterior chamber for more than 3 weeks. One month later she achieved 20/20 with Contact Lens. During the first year after reattachment it was necessary to change the CL due to an increasing with the rule astigmatism from 3D to 5D. Results Two years after gas injection BSVA is 20/25 because she is no longer using CL, Descemet´s membrane still remains well attached, even thought we realized that there was a trend to steepen the vertical meridian due to the widening of a nasal arcuate incision, that we think was the origin of the DMD. Conclusion DMD is a rare complication of Phacoemulsification, seen immediately after the surgery. So far there has not reported any complete DMD after phaco after PK. We think that it is mandatory to perform a corneal OCT in all cases of PK and stromal edema; it could probably be a DMD. [source]

    Endophthalmitis in the western Sydney region: a case-control study

    Somsak Lertsumitkul FRACO
    ABSTRACT Background: A retrospective case-control study was conducted to investigate risk factors for endophthalmitis following routine intraocular surgery. Methods: A review was performed of consecutive cases of endophthalmitis from three teaching hospitals in the western Sydney region and matched controls from the same institutions between 1996 and 1998. Results: There were 31 cases and 66 controls. Eighty procedures were phacoemulsification, 15 conventional extracapsular cataract extraction, and two were penetrating keratoplasties. Of the 80 patients who had phacoemulsification surgery, 50 had a clear corneal incision, and 26 had a scleral incision (four were unknown). Logistic regression showed an increased risk of endophthalmitis with surgical complications (P = 0.002) and clear cornea temporal incisions (P = 0.007). Risk of endophthalmitis was reduced with use of subconjunctival injections (P = 0.008). The yield for the Gram stain was 47% and for culture was 67%. Anterior chamber tap in addition to vitreous biopsy alone did not increase the yield for microorganism (P = 0.78). Mean visual acuity on presentation was hand movement with 13 patients (50%) showing visual improvement following intravitreal injections of antibiotics (P = 0.003). Visual prognosis did not correlate with presenting visual acuity but appeared to be better in those who grew Staphylococcus epidermidis or were culture negative. Conclusions: Although this study is unable to draw definite conclusions regarding risk of endophthalmitis in clear corneal temporal cataract surgery, sufficient data suggest the importance of incision type and location. Surgical complication is an important risk factor for endophthalmitis. Use of subconjunctival antibiotic injections at the conclusion of the procedure is recommended. [source]

    Atropine-induced lens extrusion in an open eye surgery

    Summary A 2-month-old male baby undergoing penetrating keratoplasty (PKP) under general anesthesia developed bradycardia and a decrease in heart rate to 53 b·min,1 when stay sutures were taken through the superior and inferior rectii. A bolus of 0.1 mg intravenous atropine resulted in tachycardia of up to 180,220 b·min,1, which persisted for 35 min. After corneal trephination was performed the eyeball seemed to pulsate with the heartbeat. Spontaneous extrusion of the lens and vitreous occurred, which necessitated a lensectomy and vitrectomy in addition to PKP. The role of atropine in corneal transplant surgery is discussed here. [source]

    Allergic Airway Hyperreactivity Increases the Risk for Corneal Allograft Rejection

    J. Y. Niederkorn
    Corneal allografts transplanted into hosts with allergic conjunctivitis experience an increased incidence and swifter tempo of immune rejection compared to corneal allografts transplanted to nonallergic hosts. Previous findings suggested that increased risk for rejection was not a local effect produced by an inflamed eye, but was due to perturbation of the systemic immune responses to alloantigens on the corneal allograft. We tested the hypothesis that another allergic disease, airway hyperreactivity (AHR), would also increase the risk for corneal allograft rejection. Induction of AHR with either ovalbumin (OVA) or short ragweed (SRW) extract prior to keratoplasty resulted in a steep increase in the speed and incidence of corneal allograft rejection. Delayed-type hypersensitivity (DTH) responses to corneal alloantigens were closely associated with corneal allograft rejection. However, the deleterious effect of AHR on corneal allograft survival was not reflected in a heightened magnitude of allospecific DTH, cytotoxic T lymphocyte and lymphoproliferative responses to the alloantigens on the corneal allograft. Unlike Th2-based immediate hypersensitivity, CD8+ T-cell-based contact hypersensitivity to oxazolone did not increase the risk for corneal allograft rejection. Thus, Th2-based allergic diseases significantly reduce the immune privilege of the corneal allograft and represent important risk factors for consideration in the atopic patient. [source]

    Serious complications of cosmetic NewColorIris implantation

    Justin E. Anderson
    Acta Ophthalmol. 2010: 88: 700,704 Abstract. Purpose:, This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods:, We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results:, Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant,iris and implant,endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. Conclusions:, Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists. [source]

    3133: Planar patch-clamping in human corneal endothelial cells: a new tool for clinical application?

    Purpose Identification of apoptotic or damaged human corneal endothelial cells (HCECs) is limited to morphological evaluation such as phase contrast microscopy and vital staining. The molecular mechanisms of corneal endothelial cell loss are not fully understood. Special investigations in cellular signalling and ion channel research are necessary to elucidate the mechanisms of corneal cell loss. In this context, it is known that this cell loss is often caused by apoptosis in oxidative stress. Methods Automated planar patch-clamp has become common in drug development and safety programs because it enables efficient and systematic testing of compounds against ion channels during voltage-clamp. A particularly successful automated approach is based on planar patch-clamp chips and this is the basis for the technology used here. Routine intracellular or extracellular perfusion opens possibilities for studying the regulation and pharmacology of ion channels. Previously, these studies were available only to highly skilled and dedicated experimenters. Results Notable, definite ion channel activities could be demonstrated by conventional as well as by planar patch-clamp in HCECs for the first time. In particular, temperature-sensing transient receptor potential (TRP)-like non-selective cation channel currents as well as capsaicin-sensitive ion channel currents could be detected. The expression of TRPV1-3 ion channels in HCEC could also be confirmed by RT-PCR, Western blot analysis and fluorescence cell imaging. Conclusion The administration of this novel measuring technology opens new perspectives in the investigation of the physiology of HCEC. The findings may have direct clinical implication (eye banking procedures, keratoplasty). [source]

    4232: OOKP protocol update

    FC LAM
    Purpose The OOKP remains the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to cadaveric keratoplasty. Falcinelli's modifications of Strampelli's technique of OOKP surgery remains the gold standard for its excellent visual and keratoprosthesis-retention results. To maintain good outcomes, aid research and to maintain standards, it is important that benchmarks are maintained in patient selection and preoperative assessment, surgical technique and post-operative care. We therefore present, for discussion, the updated protocol that is currently used in the British National OOKP Referral Centre at the Sussex Eye Hospital, Brighton. Methods Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to produce and up-to-date standard and protocol. Since then, we have continued to update our protocol on the basis of our own outcomes and findings. We present our updated protocol for discussion and for use in other OOKP centres. Results Our updated protocol includes a discussion on the indications and contraindications for surgery, criteria for patient selection, surgical technique, routine postoperative care, and the recognition and management of postoperative complications. Conclusion 5 years have passed since the standards for modified OOKP surgery were published. This paper highlights changes to this standard resulting from our practice in our national OOKP centre. [source]

    2142: Ulrastructural features of keratoconus cornea after cross-linking by riboflavin/UVA

    Purpose In the present studies we assess the effects of collagen cross-linking on ultrastructure organisation of the corneal stroma of keratoconus human corneas. Methods One normal, one keratoconus (KC) and three cross-linked keratoconus corneas were analysed. One was treated with standard cross linking (SXL) and two with trans-epithelial collagen cross linking (TEXL). Penetrating keratoplasty was performed three months after treatment. All samples were fixed in 2.5% glutaraldehyde containing cuprolinic blue in sodium acetate buffer and processed for electron microscopy. Results The structure of SXL corneas was very similar to normal corneas in their hemidesmosomes, basement membrane (BM), Bowman's layer (BW) and stromal lamellae that were not undulated. The architecture of TEXL corneas presented some differences. The BM was thick with degenerated hemidesmosomes. Bowman's layer was disorganised at some places and replaced by thin filaments forming pannus. There were thin undulating lamellae in anterior, middle and posterior stroma. The keratocytes were embedded between undulating lamellae. Large amounts of abnormal PGs were attached around collagen fibrils. The parallel running lamellae were very thin. In some parts of the anterior stroma collagen fibrils were oriented (running) in random directions instead of running parallel. There were some parts of the stroma which showed a normal appearance. Conclusion The present studies demonstrate that corneal cross-linking leads to modifications in keratocytes and in the organisation of collagen fibril. The morphological changes might be correlated to the process of increase in biomechanical stability although there are differences between stromal structures treated by standard and trans [source]

    Longterm follow-up of penetrating keratoplasty for keratoconus

    Lene Bang Jensen
    Abstract. Purpose:, This study aims to describe the current visual and refractive status of patients who underwent penetrating keratoplasty (PK) for keratoconus > 20 years ago and to report on the current status of their grafts. Methods:, A total of 138 eyes in 103 patients were grafted for keratoconus between August 1968 and December 1985. Patients who had not undergone retransplantation were invited to attend a clinical examination. Forty-eight patients (with 61 grafts) accepted the invitation and were examined. Results:, The average length of time since PK was 26.9 years (standard deviation [SD] 4.2 years, range 20.8,38.0 years, n = 61). The average graft age at examination was 82.1 years (SD 19.9 years, range 41,115 years). A total of 80% (49 of 61 grafts) of the examined eyes had a clear graft and 46% (28 of 61 eyes) had best spectacle-corrected visual acuity (BSCVA) , 0.5. The mean endothelial cell density per mm2 was 894 (SD 4.6, range 470,1775). The mean central corneal thickness of the clear grafts was 0.565 mm (SD 0.048 mm). Conclusions:, Penetrating keratoplasty for keratoconus has a good longterm prognosis; half of the eyes examined in this study had BSCVA , 0.5 at > 20 years after surgery. [source]

    Donor corneal stroma and host,donor interface vascularization after Descemet's membrane stripping with automated endothelial keratoplasty

    Katayoon B. Ebrahimi
    First page of article [source]

    Baerveldt glaucoma implants in the management of refractory glaucoma after vitreous surgery

    Elisabeth Van Aken
    Abstract. Purpose:, To examine the effectiveness and safety of Baerveldt glaucoma implants in eyes with refractory glaucoma following vitrectomy. Methods:, We performed a retrospective study of a non-comparative case series of 30 eyes of 30 patients who had undergone the implantation of a Baerveldt glaucoma device. All eyes (30/30) had a minimum follow-up of 6 months, and 16/30 (53%) had a follow-up of 24 months. Surgical success was defined as intraocular pressure (IOP) < 22 mmHg on the last two follow-up visits with or without glaucoma medication and a decrease in IOP of at least 20% compared to preoperative values with or without glaucoma medication. Results:, The mean IOP before implantation of a Baerveldt glaucoma device was 30 mmHg [± 11.4 mmHg standard deviation (SD)] with maximally tolerated medical therapy. Six months after implantation of the Baerveldt glaucoma device, the mean IOP was 17.3 mmHg (± 6.7 mmHg SD) and the mean number of glaucoma medications had gone down from 3.0 (± 0.4 SD) to 0.3 (± 0.3 SD). Successful outcomes were found in 24 eyes (80%). Small complications occurred in six eyes (20%): transient postoperative hypotony (17%) and tube retraction (3%). Larger complications occurred in another six eyes (20%): corneal decompensation requiring keratoplasty (7%), suprachoroidal haemorrhage (3%) and persistently high IOP (10%). Conclusion:, Baerveldt glaucoma devices are a valid treatment option in eyes with refractory glaucoma after vitreous surgery, although failure occurred in 20% of our patients. Transient complications occurred in 20% and severe complications in another 20%. [source]

    Lattice corneal dystrophy, gelsolin type (Meretoja's syndrome)

    Christian Carrwik
    Abstract. Purpose:, This paper reviews current knowledge about the pathogenesis, clinical manifestations and treatment of lattice corneal dystrophy, gelsolin type (LCD2, Meretoja's syndrome). Methods:, Material is derived from literature searches, a case study of a Finnish patient living in Sweden, and interviews in Helsinki with Professor Ahti Tarkkanen and Dr Sari Kiuru-Enari, both of whom have extensive first-hand experience in treating patients with the disease. Results:, The disease is now reported from several countries in Europe, as well as Japan, the USA and Iran. Treatment is symptomatic and is based on eye lubrication combined with rigorous monitoring of intraocular pressure to reduce corneal haze and postpone the need for keratoplasty. When systemic symptoms occur, the ophthalmologist should consult other specialists. Conclusions:, The disease is probably under-reported and is almost certainly to be found in more countries, including Sweden. Every ophthalmologist should be vigilant and consider this diagnosis when discovering a corneal lattice dystrophy, especially because the disease is an inherited, lifelong chronic condition with systemic symptoms. [source]

    A variant TGFBI corneal dystrophy from G623D mutation with an unusual amyloidogenic phenotype

    Purpose To present a unique corneal dystrophy never before described in a German family carrying the Gly623Asp mutation of the TGFBI gene with late clinical onset. Methods Clinical documentation and isolation of genomic DNA from peripheral blood leucocytes were obtained from each family member examined. Exons 3, 4, 5, and 11 to 14 of the TGFBI gene were sequenced. 5 corneal buttons of 3 affected siblings were excised at the time of penetrating keratoplasty. Light and electron microscopic examination were performed including immunohistochemistry with antibodies against Keratoepithelin (KE) 2 and 15. Results Specimens showed changes in Bowman's layer and the adjacent stroma. Congo red-positive amyloid deposits were found within the epithelium in one cornea, in Bowman's layer and in the anterior stroma of all specimens, also showing KE2- but not KE15-immunostaining. EM revealed deposits located in the anterior stroma and Bowman's layer and the basal area of some epithelial cells. These areas were strongly Alcian blue-positive but negative in the Masson-Trichrom-stain. Only affected patients had a heterozygous missense mutation in exon 14 of the TGFBI gene (G->A transition at nucleotide 1915) with the change Gly623Asp in the keratoepithelin protein. Conclusion In contrast to the patient carrying the Gly623Asp mutation of the TGFBI gene described by Afshari et al., our cases presented with Salzmann nodular degeneration like clinical features with KE2 positive amyloid. The reason for this now "meeting the expectation histological phenotype" is unclear. The histological findings emphasize that this is a unique corneal dystrophy which shares no clinical characteristics with Reis-Bücklers dystrophy and should be treated as a distinct entity. [source]

    TGFBI gene mutations in Hungary , polymorphic corneal amyloidosis caused by the novel F547S mutation

    Purpose To identify mutations in the Transforming Growth Factor Beta Induced (TGFBI) gene in Hungarian patients with corneal dystrophy and to characterize their histological features. Methods Exons of TGFBI gene were sequenced in 38 members of 15 unrelated families with corneal dystrophy. Exon 12 was sequenced in 100 healthy controls. Immunohistological analysis of corneal buttons excised during penetrating keratoplasty was performed. Results Molecular genetic analysis revealed a heterozygous R124C mutation in 18 patients with lattice type I dystrophy. A R555W heterozygous mutation was detected in five patients with granular Groenouw type I corneal dystrophy and the R555Q heterozygous mutation was found in four patients clinically diagnosed with Reis-Bücklers (one patient) and Thiel-Behnke (three patients) dystrophy. Three patients with "atypical granular" dystrophy later diagnosed as Avellino dystrophy were heterozygous for the R124H mutation. No other than the novel heterozygous T1640C mutation causing the F547S amino acid exchange was detected in a patient with polymorphic corneal amyloidosis. The mutation could not be found in healthy controls. Immunohistochemistry showed the presence of BIGH3 protein deposits in all examined corneal buttons. Electron microscopy confirmed the presence of amyloid fibrils in the case of the novel mutation. Conclusion Our results indicate that molecular genetic analysis is required to confirm the diagnosis of corneal dystrophies. We report the first cases of Avellino dystrophy from Central-Eastern Europe. The novel F547S mutation causes polymorphic corneal amyloidosis. [source]

    History of and necessity for KPros

    C LIU
    The history of keratoprostheses goes back over 200 years. There was a resurgence in interest in the second half of the twentieth century as it was recognised that keratoplasty could not solve all types of corneal blindness. Many devices have been described but few have survived. Corneal transplantation is complicated by graft rejection and astigmatism. There is also a problem with adequate supply, and there is a risk of transmission of infection. There is a desire for an artificial cornea which surpasses cadaveric transplantation. There is much ongoing work, but the majority of clinical work on keratoprostheses are for corneal blindness not amenable to cadaveric grafts. These can be separated into two main groups. The wet blinking eye which have had multiple graft failures, and the dry eye with a keratinised ocular surface which may also have a deficiency in lid cover. The approaches to these are quite different. [source]

    MOOKP clinical results and Indications

    Purpose To demonstrate which are the reasons that permit by the modified osteo-odonto-keratoprosthesis (Mookp) technique to obtain in 275 blind eyes,with a basic pathology where 42% of eyes were dry,and 32% had severe physical/chemical burns,excellent anatomical and functional results. Methods Tables are shown which put into evidence the best visual acuity obtained in the 275 eyes affected by corneal blindness,operated by the Mookp technique from 1973 to 2008, with a 36 years causistry,with a very long follow-up. Results 275 blind eyes. Best Visual Acuity recovered, between 10/10 and 5/10 in 80.25% of operated eyes, excellent for any working activity,( best visual acuity recovered), between 10/10 and 2/10 in 91,20%, useful for any activity. Final V.A., between 10/10 and 5/10 in 67,68%, and between 10/10 and 2/10 in 78,11%- Conclusion The reasons for these excellent results are due to the biological properties of this Kpro invented by Strampelli and to the modifications made by Falcinelli. The indications for this technique are all those types of corneal blindness not treatable by penetrating keratoplasty. [source]

    Nanostructural properties of intraocular lenses (IOLs) , atomic force microscopy (AFM) and Fourier transform infrared spectroscopy (FTIR) investigations

    Purpose To investigate and analyze surface of explanted intraocular lenses (IOL-s), by means of the Atomic Force Microscope (AFM) and Fourier transform infrared spectroscopy (FTIR). Methods Eight dry IOL-s (acrylic: SN60AT , 3 pieces, SA60AT , CZ70BD; silicone: CLRFLXC; "hard": AJPR,CP65T), and four hydrophilic acrylic IOL-s (AC-IOL and PC- IOL, both: naïve and removed during keratoplasty) were imaged (topography and phase) with AFM. AFM is used to investigate, at nanoscale, the surfaces' topography and some nanomechanical properties (eg. elasticity, hardness) of materials in medicine. The samples can be investigated in quasi-physiological conditions, usually no damaging preparation is required. For the acrylic and "hard" lenses the granular nanostructure is observed. The roughness of the lenses' surfaces can be then assessed. The silicone lens is soft: the forces of nanonewtons applied during imaging cause strong deformations of the material. Results Nanomechanical properties of PC-IOL lens are not uniform. This may be advantageous for its calcification: for the lens of the same type removed during keratoplasty strong calcification is observed. For SN60AT lens the influence of the application process (folding) on its nanostructure is tested. The observed structural nano-defects are permanent, they can occur during folding or can be caused by the used equipement. The similar nano-deformations are observed for the removed AC-IOL lens. Conclusion AFM and FTIR showed to be a high-resolution imaging tool for the scanning of surface IOL. [source]

    Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularization

    Purpose to study the effects of subconjunctival injection of Bevacizumab on corneal neovascularization. Methods Prospective interventional case series on 7 eyes of 7 patients who underwent subconjunctival injection with Bevacizumab. The following parameters were studied pre-op, at 1 week, 30, 60 and 90 days post-op: UCVA, BCVA, pachymetry with OCT, slit lamp examination and photographic imaging. Conjunctival impression cytology pre-op at 1 week and 9o days was done and complications were also noted. Results Pre-op diagnoses were: herpetic leucoma (4 eyes), chemical burn (2 eyes), neurotrofic keratopathy (1 eye). An informed off-label consent form prior to procedure was signed. 1.25 mg of subconjunctival Bevacizumab was injected nearest the area affected. Mean preoperative UCVA and BCVA were 0.86 and 0.44 LogMar units, improved to 0.61 and 0.26 LogMar units at 90 days post-op, respectively. Central and peripheral pachymetry improved from 532 and 623 microns pre-op, to 529 and 619 microns at 90 days post-op, respectively. All slit lamp findings and photographic imaging showed a clear regression of superficial and deep stromal corneal vascularization, with clearing of lipid deposits around the affected areas. No toxic effects were noted on conjunctival impression cytology. Conclusion Subconjunctival injection of Bevacizumab is a safe and effective procedure for the regression of superficial and deep corneal neovascularization. It may be a good alternative for patients prior to performing an optical keratoplasty or for those who are poor candidates for the same. [source]

    The taming of the shrew?

    The immunology of corneal transplantation
    Abstract. Corneal transplantation, first reported a century ago, is the oldest and most frequent form of solid tissue transplantation. Although keratoplasty is also considered as the most successful transplant procedure, several studies indicate that the long term survival of corneal grafts is even lower than that of transplanted parenchymatous organs. Despite the immune privilege enjoyed by the cornea and anterior segment of the eye, immunologic graft rejection is a major limitation to corneal transplantation. This review gives an update on corneal immunobiology and the mechanisms of corneal graft rejection, focusing on antigen presentation, as well as on the molecular and cellular mediators of this particular immune response. [source]

    Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty for Fuchs' endothelial dystrophy

    Jesper Hjortdal
    Abstract. Purpose:, To compare the outcome of Descemet's stripping endothelial keratoplasty (DSAEK) to that of penetrating keratoplasty (PK) in patients with Fuchs' endothelial dystrophy. Methods:, The first 20 patients who underwent DSAEK at the Department of Ophthalmology, Aarhus University Hospital were compared to 20 patients treated with classic PK. Best-corrected visual acuity, subjective spectacle refraction and corneal thickness were registered before surgery and 1, 3, 6 and 12 months after DSAEK surgery; they were also measured before surgery and 12 months and 2,3 years after PK. Endothelial cell density was measured 12 months after surgery in both groups. Results:, Two primary graft failures were observed in the DSAEK group; no failures were seen in the PK group. Best spectacle-corrected visual acuity (BSCVA) at 12 months after surgery was significantly better in the DSAEK group (0.56 ± 0.04) than in the PK group (0.33 ± 0.06). At this time, 70% of the DSAEK-treated eyes but only 25% of PK-treated eyes had obtained a BSCVA of 0.5 or better. Two to three years after surgery, BSCVA was 0.5 or better in 55% of PK-treated eyes. Refractive ametropia and astigmatism were significantly smaller in DSAEK-treated eyes than in PK-treated eyes, even after suture removal and arcuate keratotomy. Endothelial cell density (cells/mm2) after 1 year was lower in DSAEK-treated (1.338 ± 113) than in PK-treated eyes (1.610 ± 124), but the difference was not statistically significant. Conclusion:, DSAEK seems to be superior to PK in treating Fuchs' endothelial keratoplasty, although primary graft failure may be more common. Visual recovery is faster, and major ametropia and astigmatism is not induced. Long-term follow-up studies are essential to assess whether this conclusion also holds true more than 1 year after surgery. [source]

    Corneal oedema after cataract surgery: predisposing factors and corneal graft outcome

    Margareta Claesson
    Abstract. Purpose:, Pseudophakic bullous keratopathy (PBK) is one of the main indications for corneal transplantation. Graft survival and visual outcome in this group are often poorer than for other indications. The aim of this study was to find risk factors for developing corneal oedema after cataract surgery and factors that influence the subsequent survival of the graft and the visual outcome. Methods:, We carried out an observational, retrospective cohort study using data from the Swedish Cornea Transplant Register and patient medical records. A total of 273 patients whose indication for corneal transplantation was corneal oedema after cataract surgery were included in the study. Multiple logistic regression analysis and, where appropriate, univariate analyses were applied. Results:, A total of 43% of the patients developed persistent corneal oedema immediately after cataract surgery, the main risk factors for which were phacoemulsification and pre-existing endothelial disease. Almost a third (32%) of the transplants for PBK failed within 2 years, for which rejection and other postoperative complications increased the risk. Half (50%) the patients had visual acuity , 0.1 at 2 years after keratoplasty. Comorbidity, increasing duration of the bullous keratopathy and increasing age affected the visual outcome negatively. Conclusions:, Phacoemulsification was a risk factor for immediate persistent corneal oedema after cataract surgery, although it did not increase the overall risk of developing PBK. However, transplants for immediate PBK had a better survival rate than those for later onset PBK. Shorter duration of PBK and intraocular lens exchange at the time of penetrating keratoplasty increased the likelihood of good visual acuity. [source]

    Medical treatment for combined Fusarium and Acanthamoeba keratitis

    Hsin-Chiung Lin
    Abstract. Purpose:,Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment. Methods:, We reviewed the medical records of patients treated for culture-proven Acanthamoeba keratitis at a referral centre, during 2001,2006. Results:, Eleven consecutive patients were treated for culture-proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29-year-old man presented with ground-glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7-year-old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case. Conclusions:, Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty. [source]

    The taming of the shrew or corneal transplantation: past, present and future

    Keratoplasty has definitely its paradoxes. It has been the first successful transplantation in man and is with approx. 100. 000 grafts/year easily the most frequent allograft in human medicine. At the same time it is still the least understood form of transplantation in respect to its biology. It is both, the most successfull as well as probably the most underestimated procedure regarding its risks in clinical transplantation. Indeed, the common assumtion, that corneal transplantation is a safe procedure with good prognosis may have hindered more intensive effort of research in this field. This lecture aims to highlight significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated individuals involved in the development of keratoplasty. There are still limitations to corneal transplantation, and corneal allograft rejection still poses the greatest challenge to the modern corneal surgeon. Therefore, particular emphasis will be paid to recent efforts and developments to overcome this challenge. [source]

    Longterm results of deep lamellar keratoplasty using grafts with endothelium

    Shiro Higaki
    Abstract. Purpose:, To report the longterm results of deep lamellar keratoplasty (DLK) using grafts with their own endothelia. Methods:, Fourteen eyes of 14 patients underwent DLK using grafts with endothelium. The average follow-up was approximately 80.0 months. Preoperative diagnoses included: corneal leukoma (five eyes); gelatinous drop-like corneal dystrophy (three eyes); Avellino corneal dystrophy (two eyes); corneal perforation (two eyes); corneal mucopolysaccharidosis (one eye), and keratoconus (one eye). Results:, Corrected visual acuity was improved in 13 eyes (93%), but ruptures of Descemet's membrane occurred in six eyes (43%) and a double anterior chamber was found in five eyes (36%) postoperatively. Despite this, all grafts remained clear as a result of their functioning endothelia. Conclusions:, Deep lamellar keratoplasty using a graft with its own endothelium is a safe and valuable procedure with flexibility and feasibility that should suit corneal surgeons of all levels. [source]

    Corneal penetration of simultaneously applied topical levofloxacin, norfloxacin and lomefloxacin in human eyes

    Masakazu Yamada
    Abstract. Purpose:,This study was performed to assess the corneal penetration of three topically applied fluoroquinolones (levofloxacin, norfloxacin and lomefloxacin) in corneal buttons obtained from patients undergoing penetrating keratoplasty. Methods:,Fourteen patients received three drops each of 0.5% levofloxacin, 0.3% norfloxacin and 0.3% lomefloxacin (the standard clinically available preparations) over a 30-min interval beginning 90 mins before their scheduled keratoplasty. Corneal samples obtained from excised buttons at the time of surgery were stored at , 80 ° until analysis. The concentration of the administered fluoroquinolones was measured using high-performance liquid chromatography. Results:,The mean corneal concentration of levofloxacin (4.6 ± 3.5 µg/g, mean ± standard deviation) was significantly higher than that of lomefloxacin (2.7 ± 1.8 µg/g, p = 0.0018) and norfloxacin (1.3 ± 1.2 µg/g, p = 0.00012). Conclusion:,Levofloxacin achieves a higher mean corneal concentration than norfloxacin and lomefloxacin in the human cornea. [source]

    Longterm survival of transplanted human corneal epithelial cells and corneal stem cells

    Maria Egarth
    Abstract. Purpose:,To investigate the survival of donor-derived epithelial cells in conventional penetrating keratoplasty (PKP) and in homologous penetrating central limbal keratoplasty (HPCLK). Methods and Patients:,Epithelial cells from 26 eyes of 26 patients were analysed. All cases were sex-mismatched (i.e. the transplant and patient were of different genders). At suture removal more than 1 year post surgery, epithelial cells were obtained by gently wiping the removed sutures on glass slides. The cell samples were analysed using fluorescent in situ hybridization (FISH) of the sex chromosomes. This technique makes it possible to allocate the origin of each cell nucleus to either the donor or the recipient. Results:,All 19 conventional PKPs were clear and seven had donor-derived epithelial cells at suture removal. Five of the seven HPCLK grafts were clear at the time of investigation (365,1355 days post surgery), and donor-derived epithelial cells were found in two grafts. Conclusion:,Harvesting cells from removed sutures in combination with FISH enables the clinical study of cell survival in corneal transplants without jeopardizing functioning grafts. From the limited sample investigated, the following tentative conclusions can be made. Donor-derived epithelial cells can remain in conventional PKP for over 1 year. In combined stem cell and corneal grafts (HPCLK), donor-derived epithelial cells may also be retrieved at 1 year or beyond following surgery but the correlation between their presence and a remaining clear graft is uncertain. [source]

    Intraocular lens power prediction for triple procedures in Fuchs' dystrophy using multiple regression analysis

    Anja Viestenz
    Abstract. Purpose:,To develop a correcting term for intraocular power (IOLP) prediction for penetrating keratoplasty combined with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure). Methods:,As part of a prospective clinical study, triple procedures were performed in 42 eyes with Fuchs' dystrophy. Only eyes with readable preoperative K-values were included in this study. Differences (DEV) between achieved and target refraction (TR) depending on the values of the theoretical-optical formula according to HAIGIS were investigated using multiple regression analysis in a linear anova model: DEV = a + b CP + c AL + d IOLP + e TR. CP represents central corneal power, AL represents axial length. Results:,Spherical equivalent after suture removal was , 1.39 ± 2.86 D (TR: , 1.64 ± 1.72 D). A multiple regression formula was developed for correction of conventionally calculated IOL power. CP (b = , 1.391, p = 0.028), AL (c = , 4.733, p = 0.007), IOLP (d = , 1.301, p = 0.009) and TR (e = , 1.804, p = 0.005) correlated significantly with DEV (a = 198.684). Conclusion:,Proposed correcting multiple regression formula for IOL power prediction may help to improve the postoperative refractive outcome in patients undergoing triple procedures. [source]