The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by ...The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.展开更多
Dear Editor,We report a surgical method for treating repeat Descemet’s membrane(DM)detachments in two cases with DM micro-perforation during deep anterior lamellar keratoplasty(DALK).DM micro-perforation is a common ...Dear Editor,We report a surgical method for treating repeat Descemet’s membrane(DM)detachments in two cases with DM micro-perforation during deep anterior lamellar keratoplasty(DALK).DM micro-perforation is a common intraoperative complication that occurs during the performance of DM baring in DALK,using methods such as the bigbubble air technique[1].The sequelae of DM micro-perforations include postoperative DM detachments,higher endothelial cell loss,endothelial decompensation,and transplant interface scarring[2].展开更多
BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To dete...BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.展开更多
Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on d...Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.展开更多
AIM： To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology （VNIO） over a period of 12y （2002-2013）, METHODS： Records of patients who had undergone...AIM： To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology （VNIO） over a period of 12y （2002-2013）, METHODS： Records of patients who had undergone corneal transplantation at VNIO from January 1, 2002 to January 1, 2014 were reviewed to determine the indication for and type of corneal transplant performed. Patient age, gender, indication for corneal transplantation and surgical technique were recorded and analyzed. RESULTS： Corneal transplantation were underwent in 1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review. The most common indication was infectious corneal ulcer （n=670; 48.2%）, followed by corneal scar （n=333, 24.0% ）, corneal dystrophy （n=138, 9.9%） and failed graft （n=112, 8.1%）. Nearly all procedures performed were penetrating keratoplasty （n=1300, 93.5% ）, with a few lamellar keratoplasty procedures performed： lamellar keratoplasty （n=52, 3.7%）, Descemet＇s stripping automated endothelial keratoplasty （n =27, 1.9% ） and deep anterior lamellar keratoplasty （n =11, 0.8%）.CONCLUSION： While the most common indication for keratoplasty was infectious keratitis, nearly all indications for corneal transplantation were managed with penetrating keratoplasty, However, lamellar keratoplasty techniques, including deep anterior lamellar keratoplasty and Descemet＇s stripping automated endothelial keratoplasty, are being performed with increasing frequency for isolated stromal and endothelial disorders, respectively,展开更多
Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cor...Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.展开更多
Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received fu...Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.展开更多
AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes o...AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.展开更多
· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patien...· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patients treated with PK and DALK, respectively, between March 2006 and April 2010. Corneal ECD was examined using specular microscopy at postoperative 1, 3, 6, 12, and 18 months, and the values were compared. · RESULTS: Corneal ECD reduction in the PK group was 7.4%, 15.2%, 23.5%, and 28.9% at 3, 6, 12 and 18 months respectively after surgery, compared with 4.2 % in the first month (P <0.01). These figures were 3.0%, 6.7%, 7.2%, and 7.7% at 3, 6, 12 and 18 months respectively, compared with 2.2 % in the first month in the DALK group (P >0.05). · CONCLUSION: Compared with DALK,PK significantly reduced ECD of the clear grafts. These results suggest that survival of endothelial cells in grafts is better after DALK than after PK. ·展开更多
AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patie...AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.展开更多
To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamell...To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamellar corneosclerai graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm （6.0-12.0 mm）. Mean visual acuities （in IogMAR units） before and after surgery were 1.8 and 1.7, respectively （P=0.29）. Spherical equivalents were 1.3 diopter （D） before surgery and 0.7 D after surgery （P=0.40）. The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively （P=0.17）. Vector analysis revealed a mild change in astigmatism with a mean ＂d＂ of 3,2 （0,56-6.89）, No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.展开更多
AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of ons...AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of onset and risk factors of corneal ectasia.METHODS:Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed.Final Pentacam scans were evaluated together with vision and previous topographies.Main outcome measures were vision,K values,apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements.Anterior segment optic coherence tomography was performed for further evaluation.RESULTS:Mean follow-up was 127.2mo(24–282mo)in PK,and 64.3mo(24–144mo)in DALK.K max was higher in DALK(60.6 vs 56.7 D,P=0.012).Inferior recipient was thinner(595.9μm)in PK than DALK(662.2μm,P=0.021),due to longer follow-up.Overall corneal ectasia rate was 20.0% within 24y.Ectasia rate was the same(6.7%)in DALK 2/30 and in PK 4/60 in 10y and 13.3%in 12y(4/30 and 8/60,respectively).It increased to 23.3%(14/60)in PK over 24y.While ectasia was not seen before 7y in PK,it could be seen in DALK starting from the 5^(th) year.The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK.Inferior recipient was significantly thinner in 18 eyes with ectasia(502.7μm)compared to 76 non-ectasia(649.1μm,P=0.000).Inferior graft was thinner(561.0 vs 620.4μm,P=0.006),K max(63.3 vs 56.5 D,P=0.000),and anterior elevation was higher in ectasia(89.1 vs 48.6μm,P=0.002).Accelerated crosslinking was performed on 5 eyes.CONCLUSION:Inferior-superior recipient and inferior graft thinning on tomography,with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia.The incidence of corneal ectasia increases with the time.展开更多
AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to te...AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.展开更多
Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stab...Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stable advanced keratoconus and a mean age of 33 ± 8.4 years were included in the study. FRAK was performed in all cases with the IntraLase 60 kHz (Abbott Medical Optics Inc.). A 2-step resection of corneal stroma was performed using the femtosecond laser, with the generation of a circular corneal flap with wedge-shaped profile. After flap removal, the corneal wound was sutured. Results: The surgical procedure and early postoperative period were uneventful in all cases. Mean uncorrected distance visual acuity (UDVA) improved significantly from 0.07 ± 0.03 preoperatively to 0.26 ± 0.13 at 3 months after surgery. Improvement in corrected distance visual acuity (CDVA) was observed in 94.1% of cases, with 76.5% of eyes showing an improvement of more than 3 lines. Between 3 and 6 months after surgery, an additional improvement was observed in UDVA and CDVA. Corneal cylinder decreased significantly from 9.1 ± 3.8 D preoperatively to 4.4 ± 2.75 D at 6 months postoperatively. Conclusions: FRAK may be an alternative treatment in stable advanced keratoconus, allowing a significant visual improvement and corneal regularization while saving the patient's own corneal tissue. The non-penetrating nature of the surgical technique helps to minimize the risks associated to this type of surgery. Further research is needed to determine the functional long-term outcomes.展开更多
AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the ...AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P = 0.961), corneal graft dear rate (P=0.132) or the incidence of recurred fungal infection (P=0.770) between two groups. But there was a higher incidence of graft rejection (P=0.020) and secondary glaucoma (P=0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.展开更多
·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case se...·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet’s membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.展开更多
AIM: To compare long-term postoperative outcomes of manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty(FS-DALK) for keratoconus.METHODS: In the retrospective study, 17 consecut...AIM: To compare long-term postoperative outcomes of manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty(FS-DALK) for keratoconus.METHODS: In the retrospective study, 17 consecutive eyes that underwent vertical side cut incision FS-DALK and 22 eyes that underwent trephine incision DALK were collected over a 2-year period. Main measurements included postoperative uncorrected-visual acuity(UCVA), corrected distance visual acuity(CDVA), refractive sphere and cylinder, manifest refraction spherical equivalent(MRSE), flat and steep corneal keratometry(K1 and K2), endothelial cell density(ECD), and time of epithelium healing and suture removal.RESULTS: Groups were comparable for diagnosis and preoperative visual acuity. Follow-up averaged 23 mo(range, 12-36 mo). At 12 mo, the mean UCVA was better in the manual-DALK group(P=0.039), and the refractive sphere was lower in the FS-DALK group(P=0.040). MRSE between groups differed at 1, 6, and 12 mo postoperatively(P=0.047, 0.025, 0.042, respectively). Mean CDVA, cylinder, K1, K2,corneal astigmatism, ECD, and time of epithelium healing were similar between groups. Stability of MRSE, ECD, and K1 returned sooner after FS-DALK. Initial loosened suture removal time was earlier in the manual-DALK group(P=0.042) while complete suture removal time was similar(P=0.122).CONCLUSION: Manual and femtosecond assisted corneal trephination in DALK are options for advanced keratoconus. FS-DALK do not result in improved visual acuity but it is more stable during the follow-up period. FSDALK in the present form show limited benefit, so surgical design and parameters still need to be optimized and explored.展开更多
Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in...Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.展开更多
AIM: To identify the current indications and the trend shifts for penetrating keraboplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 t...AIM: To identify the current indications and the trend shifts for penetrating keraboplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. RESULTS: A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). CONCLUSION: Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.展开更多
AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the dat...AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up【8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.展开更多
文摘The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.
基金Supported by Guangdong Basic Research Center of Excellence for Major Blinding Eye Diseases Prevention and Treatment(No.2024-YXGG-016).
文摘Dear Editor,We report a surgical method for treating repeat Descemet’s membrane(DM)detachments in two cases with DM micro-perforation during deep anterior lamellar keratoplasty(DALK).DM micro-perforation is a common intraoperative complication that occurs during the performance of DM baring in DALK,using methods such as the bigbubble air technique[1].The sequelae of DM micro-perforations include postoperative DM detachments,higher endothelial cell loss,endothelial decompensation,and transplant interface scarring[2].
文摘BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.
基金Supported by The Ophthalmic Research Center,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
文摘AIM： To report the indications for and techniques of corneal transplantation at Vietnam National Institute of Ophthalmology （VNIO） over a period of 12y （2002-2013）, METHODS： Records of patients who had undergone corneal transplantation at VNIO from January 1, 2002 to January 1, 2014 were reviewed to determine the indication for and type of corneal transplant performed. Patient age, gender, indication for corneal transplantation and surgical technique were recorded and analyzed. RESULTS： Corneal transplantation were underwent in 1390 eyes of 1278 patients with a mean age of 44.9±18.1y during the period under review. The most common indication was infectious corneal ulcer （n=670; 48.2%）, followed by corneal scar （n=333, 24.0% ）, corneal dystrophy （n=138, 9.9%） and failed graft （n=112, 8.1%）. Nearly all procedures performed were penetrating keratoplasty （n=1300, 93.5% ）, with a few lamellar keratoplasty procedures performed： lamellar keratoplasty （n=52, 3.7%）, Descemet＇s stripping automated endothelial keratoplasty （n =27, 1.9% ） and deep anterior lamellar keratoplasty （n =11, 0.8%）.CONCLUSION： While the most common indication for keratoplasty was infectious keratitis, nearly all indications for corneal transplantation were managed with penetrating keratoplasty, However, lamellar keratoplasty techniques, including deep anterior lamellar keratoplasty and Descemet＇s stripping automated endothelial keratoplasty, are being performed with increasing frequency for isolated stromal and endothelial disorders, respectively,
文摘Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.
基金Project (No. 2011C13029-2) supported by the Major Program for Science and Technology Research of Zhejiang Province, China
文摘Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.
基金Supported by Science Research Foundation of Aier Eye Hospital Group(No.AFl44D11)
文摘AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.
文摘· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patients treated with PK and DALK, respectively, between March 2006 and April 2010. Corneal ECD was examined using specular microscopy at postoperative 1, 3, 6, 12, and 18 months, and the values were compared. · RESULTS: Corneal ECD reduction in the PK group was 7.4%, 15.2%, 23.5%, and 28.9% at 3, 6, 12 and 18 months respectively after surgery, compared with 4.2 % in the first month (P <0.01). These figures were 3.0%, 6.7%, 7.2%, and 7.7% at 3, 6, 12 and 18 months respectively, compared with 2.2 % in the first month in the DALK group (P >0.05). · CONCLUSION: Compared with DALK,PK significantly reduced ECD of the clear grafts. These results suggest that survival of endothelial cells in grafts is better after DALK than after PK. ·
基金Supported by the National Natural Science Foundation of China (No.81500703)the Natural Science Foundation of Shandong Province (No.ZR2015YL027)the Innovation Project of Shandong Academy of Medica Sciences
文摘AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.
基金Supported by the Research to Prevent Blindness Unrestricted Grant(New York,USA)the National Eye Institute core grant(No.P30-EY14801)(Bethesda,Maryland,USA)
文摘To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients （mean age： 13.0y） who had undergone limbal dermoid excision with lamellar corneosclerai graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm （6.0-12.0 mm）. Mean visual acuities （in IogMAR units） before and after surgery were 1.8 and 1.7, respectively （P=0.29）. Spherical equivalents were 1.3 diopter （D） before surgery and 0.7 D after surgery （P=0.40）. The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively （P=0.17）. Vector analysis revealed a mild change in astigmatism with a mean ＂d＂ of 3,2 （0,56-6.89）, No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.
文摘AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of onset and risk factors of corneal ectasia.METHODS:Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed.Final Pentacam scans were evaluated together with vision and previous topographies.Main outcome measures were vision,K values,apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements.Anterior segment optic coherence tomography was performed for further evaluation.RESULTS:Mean follow-up was 127.2mo(24–282mo)in PK,and 64.3mo(24–144mo)in DALK.K max was higher in DALK(60.6 vs 56.7 D,P=0.012).Inferior recipient was thinner(595.9μm)in PK than DALK(662.2μm,P=0.021),due to longer follow-up.Overall corneal ectasia rate was 20.0% within 24y.Ectasia rate was the same(6.7%)in DALK 2/30 and in PK 4/60 in 10y and 13.3%in 12y(4/30 and 8/60,respectively).It increased to 23.3%(14/60)in PK over 24y.While ectasia was not seen before 7y in PK,it could be seen in DALK starting from the 5^(th) year.The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK.Inferior recipient was significantly thinner in 18 eyes with ectasia(502.7μm)compared to 76 non-ectasia(649.1μm,P=0.000).Inferior graft was thinner(561.0 vs 620.4μm,P=0.006),K max(63.3 vs 56.5 D,P=0.000),and anterior elevation was higher in ectasia(89.1 vs 48.6μm,P=0.002).Accelerated crosslinking was performed on 5 eyes.CONCLUSION:Inferior-superior recipient and inferior graft thinning on tomography,with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia.The incidence of corneal ectasia increases with the time.
文摘AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.
文摘Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stable advanced keratoconus and a mean age of 33 ± 8.4 years were included in the study. FRAK was performed in all cases with the IntraLase 60 kHz (Abbott Medical Optics Inc.). A 2-step resection of corneal stroma was performed using the femtosecond laser, with the generation of a circular corneal flap with wedge-shaped profile. After flap removal, the corneal wound was sutured. Results: The surgical procedure and early postoperative period were uneventful in all cases. Mean uncorrected distance visual acuity (UDVA) improved significantly from 0.07 ± 0.03 preoperatively to 0.26 ± 0.13 at 3 months after surgery. Improvement in corrected distance visual acuity (CDVA) was observed in 94.1% of cases, with 76.5% of eyes showing an improvement of more than 3 lines. Between 3 and 6 months after surgery, an additional improvement was observed in UDVA and CDVA. Corneal cylinder decreased significantly from 9.1 ± 3.8 D preoperatively to 4.4 ± 2.75 D at 6 months postoperatively. Conclusions: FRAK may be an alternative treatment in stable advanced keratoconus, allowing a significant visual improvement and corneal regularization while saving the patient's own corneal tissue. The non-penetrating nature of the surgical technique helps to minimize the risks associated to this type of surgery. Further research is needed to determine the functional long-term outcomes.
基金National Natural Science Foundation of China (No.81170825)
文摘AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P = 0.961), corneal graft dear rate (P=0.132) or the incidence of recurred fungal infection (P=0.770) between two groups. But there was a higher incidence of graft rejection (P=0.020) and secondary glaucoma (P=0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.
基金National Natural Science Foundation of China (No. 81270979)Natural Science Foundation of Jiangsu Province, China (No.BK2012777)
文摘·AIM: To describe the initial outcomes and safety of femtosecond laser-assisted deep anterior lamellar keratoplasty(DALK) for keratoconus and post-LASIK keratectasia.·METHODS: In this non-comparative case series, 10 eyes of 9 patients underwent DALK procedures with a femtosecond laser(Carl Zeiss Meditec AG, Jena,Germany). Of the 9 patients, 7 had keratoconus and 2had post-LASIK keratectasia. A 500 kHz VisuMax femtosecond laser was used to perform corneal cuts on both donor and recipient corneas. The outcome measures were the uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA), corneal thickness,astigmatism, endothelial density count(EDC), and corneal power.·RESULTS: All eyes were successfully treated. Early postoperative evaluation showed a clear graft in all cases. Intraoperative complications included one case of a small Descemet’s membrane perforation.Postoperatively, there was one case of stromal rejection,one of loosened sutures, and one of wound dehiscence.A normal corneal pattern topography and transparency were restored, UCVA and BCVA improved significantly,and astigmatism improved slightly. There was no statistically significant decrease in EDC.· CONCLUSION: Our early results indicate that femtosecond laser-assisted deep anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology. This approach shows promise as a safe and effective surgical choice in the treatment of keratoconus and post-LASIK keratectasia.
基金Supported by the Innovation Project of Shandong Academy of Medical Sciences。
文摘AIM: To compare long-term postoperative outcomes of manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty(FS-DALK) for keratoconus.METHODS: In the retrospective study, 17 consecutive eyes that underwent vertical side cut incision FS-DALK and 22 eyes that underwent trephine incision DALK were collected over a 2-year period. Main measurements included postoperative uncorrected-visual acuity(UCVA), corrected distance visual acuity(CDVA), refractive sphere and cylinder, manifest refraction spherical equivalent(MRSE), flat and steep corneal keratometry(K1 and K2), endothelial cell density(ECD), and time of epithelium healing and suture removal.RESULTS: Groups were comparable for diagnosis and preoperative visual acuity. Follow-up averaged 23 mo(range, 12-36 mo). At 12 mo, the mean UCVA was better in the manual-DALK group(P=0.039), and the refractive sphere was lower in the FS-DALK group(P=0.040). MRSE between groups differed at 1, 6, and 12 mo postoperatively(P=0.047, 0.025, 0.042, respectively). Mean CDVA, cylinder, K1, K2,corneal astigmatism, ECD, and time of epithelium healing were similar between groups. Stability of MRSE, ECD, and K1 returned sooner after FS-DALK. Initial loosened suture removal time was earlier in the manual-DALK group(P=0.042) while complete suture removal time was similar(P=0.122).CONCLUSION: Manual and femtosecond assisted corneal trephination in DALK are options for advanced keratoconus. FS-DALK do not result in improved visual acuity but it is more stable during the follow-up period. FSDALK in the present form show limited benefit, so surgical design and parameters still need to be optimized and explored.
文摘Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.
基金Supported by National Natural Science Foundation of China(No.30630063)
文摘AIM: To identify the current indications and the trend shifts for penetrating keraboplasty (PKP) in Shandong. METHODS: The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1, 2005 to May 31, 2010 were analysed retrospectively. RESULTS: A total of 875 patients (875 eyes) received PKP in this 5-year period, accounting for 61.6% of all corneal transplantation surgeries. The leading indications for PKP were infectious keratitis (37.1%), HSK (19.1%), keratoconus (11.2%), bullous keratopathy (8.5%), regrafting (6.7%) and corneal scarring (4.8%). The percentage of PKP for keratoconus declined year by year, whereas the percentage of bullous keratopathy had a mild annual increase. Fungal infections accounted for 65.2% of the infectious keratitis cases, remaining the leading cause of corneal infection. In addition, 54.1% of bullous keratopathy cases were associated with cataract surgery. The leading initial diagnoses associated with regrafting were infectious keratitis (38.9%), HSK (18.6%) and corneal burn (16.9%). The major causes of regrafting included graft endothelial dysfunction (39.0%), graft ulcer (28.8%) and primary disease recurrence (15.3%). CONCLUSION: Infectious keratitis remained the leading indication for PKP in Shandong, and fungal infections were still the major cause of corneal infections. There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus. Even with a decline in the overall proportion among all corneal transplantation surgeries, PKP is still the major corneal transplant choice in Shandong.
文摘AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up【8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.
