Complications Of Keratoplasty Research Articles

Postkeratoplasty Corneal Plaques: A Case Series.

To assess the risk factors and management of corneal plaques formed after keratoplasty. In this retrospective study, medical records of all eyes with plaques formed on top of corneal grafts performed in the period between January 2014 and January 2022 were reviewed. The retrieved data included prekeratoplasty corneal pathology, ocular risk factors, operative data and complications, plaque management, and chemical composition of the plaques using infrared spectrometer. Thirteen eyes were included in this study. Predisposing ocular comorbidities included ocular surface disorders with variable degrees of dry eye in nine patients, rheumatoid arthritis in three patients, history of herpetic keratitis in two eyes, and cicatrizing conjunctivitis in two patients. Surgical excision and amniotic membrane transplantation (AMT) were performed in 12 eyes. Postoperatively, five eyes showed recurrence after excision, two eyes developed graft vascularization and scarring, and one eye showed persistent epithelial defect and graft scarring, whereas four eyes showed complete epithelialization with mild haze. Rekeratoplasty and AMT were performed in two eyes with no plaque recurrence. Chemical analysis using infrared spectrometry showed that the plaques consisted of ammonium magnesium phosphate and calcium phosphate carbonate in 9 (75%) cases and pure mucus in 3 (25%) cases. Postkeratoplasty corneal plaque formation is an underestimated complication of keratoplasty that may occur after persistent epithelial defects. Ocular surface disorders are the primary predisposing risk factors. In our experience, the prognosis after medical treatment or surgical scraping is guarded, and regrafting can be the only solution to restore graft clarity.

Anterior segment optical coherence tomography for the detection and management of early keratoplasty complications

AbstractPurpose: This study aimed to assess the contribution of anterior segment optical coherence tomography (AS‐OCT) in the detection of early postoperative complications following penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in order to guide their management.Methods: A single‐center, prospective study, designed to evaluate the postoperative results of 42 eyes who had PK (39 eyes) and DALK (3 eyes) for various diagnoses. Complications occurring between the first and 7th day after surgery were recorded. AS‐OCT was performed to assess central corneal thickness (CCT), Descemet's membrane (DM) position, graft‐host junctions (GHJ), and iridocorneal angle (ICA) opening.Results: Early postoperative complications were detected in 4 eyes (9.5%). Among them, 2 eyes (patients 1 and 2) had PK for corneal perforation, and 2 eyes (patients 3 and 4) had DALK for keratoconus. Patient 1 had an early graft ectasia. Corneal thinning was first detected on the 6th postoperative day by CCT measurement on AS‐OCT. He underwent a second PK with a favourable outcome. Patient 2 had persistent corneal edema on the 4th postoperative day. AS‐OCT revealed graft steps at the GHJ. After surgical revision, the graft became clear and the GHJ were well‐apposed on AS‐OCT. Patient 3 had important graft edema (CCT 1005 μm) secondary to DM detachment diagnosed on the first postoperative day with AS‐OCT. She was treated with an intracameral air injection leading to the reattachment of DM and regression of the edema. Patient 4 had on the first postoperative day a pupillary block successfully managed with a peripheral iridotomy leading to the reopening of the ICA seen on AS‐OCT.Conclusions: AS‐OCT is a non‐contact and reproducible imaging tool that proved to be useful to identify early postoperative complications after keratoplasty and to guide their management. It allows for a quantitative and objective assessment of the anterior segment behind a usually non‐transparent corneal graft.

Corneal graft melting: a systematic review.

Corneal graft melting is a severe complication of keratoplasty. This review is to summarize the incidence, the pathogenesis, the risk factors, the prognosis and the prevention of corneal graft melting after keratoplasty. We systematically searched PubMed, Web of Science and WanFang database to retrieve potentially eligible articles about relevant clinical reports and animal experiments. We read the full texts to identify eligible articles. The selection of studies and data extraction were performed independently by two reviewers. In conclusion, the pathogenesis of corneal graft melting is complicated, and many risk factors are closely related to corneal graft melting. Analysis of pathogenesis and risk factors of corneal graft melting can facilitate the development of targeted therapies to better guide clinical practice.

Prevention and Management of Descemet Membrane Endothelial Keratoplasty Complications.

To describe Descemet membrane endothelial keratoplasty (DMEK) complications and strategies for their prevention and management. Five hundred consecutive eyes with DMEK of 393 patients were reviewed in this retrospective study for intraoperative and postoperative complications up to 2 years and for corresponding management. Intraoperative challenges (difficult graft unfolding/positioning, high vitreous pressure, iris root hemorrhage, and Descemet membrane remnants) were encountered in 81 eyes (16.2%). Visually significant graft detachment was the main postoperative complication (34 eyes, 6.8%). Graft failure occurred in 8 eyes (1.6%). Other postoperative complications were an increase of intraocular pressure/decompensated glaucoma in 48 eyes (9.6%), significant cataract in 11 of 124 phakic eyes (8.9%), allograft rejection in 7 eyes (1.4%), cystoid macular edema in 5 eyes (1.0%), microbial keratitis in 2 eyes (0.4%), and retinal detachment in 1 eye (0.2%). Different strategies for prevention and management of these complications have been identified. DMEK shows acceptable rates of complications up to 2 years after surgery, which can be managed successfully. Anticipation of potential challenges and difficulties may aid in modifying intraoperative strategies for predisposed eyes. This knowledge may further minimize complications, in particular, when performing DMEK for an extended spectrum of corneal endothelial disorders.

Fixed Dilated Pupilla as a Common Complication of Deep Anterior Lamellar Keratoplasty Complicated with Descemet Membrane Perforation

To report 8 cases of fixed dilated pupilla (FDP) (Urrets-Zavalia syndrome) following deep anterior lamellar keratoplasty (DALK) with Descemet membrane (DM) perforation and change of management to avoid FDP. Retrospective analysis of 106 eyes of 94 patients who underwent DALK for various diagnoses was performed. Intraoperative and postoperative details of eyes that developed DM detachment, FDP, as well as change of management to prevent rise of intraocular pressure (IOP) (as a common trait of these eyes) were evaluated. Descemet membrane perforation developed in 17 (16%) eyes. Fixed dilated pupilla was diagnosed in 8 (7.5%) eyes. Seven of the eyes with FDP experienced DM perforation and air bubble was left in anterior chamber (AC) to tamponade DM perforation at the end of the surgeries. Five eyes developed FDP in the early postoperative period and the remaining 2 eyes, which were diagnosed as double AC and managed by repeated air injections, developed FDP in the third postoperative week. The last patient who experienced intense postoperative inflammation had a fixed dilated pupil in the third postoperative week. Fixed dilated pupilla is an uncommon but well-known complication of keratoplasty. The exact mechanism remains unknown but postoperative high IOP seems to be an important risk factor following complicated DALK. Rise in IOP during the management of complications following DALK related to DM was found to be important in the development of FDP in this series.

Cataract Extraction and Toric Intraocular Lens Implantation for the Management of Pellucid Marginal Degeneration and Cataract

ABSTRACT We report cataract surgery with toric intraocular lens implantation for the management of senile cataract combined with pellucid marginal degeneration. A 72-year-old man with bilateral senile cataract and significant against-the-rule astigmatism sought counseling for blurry vision and glare, mostly in the right eye. Based on ophthalmic examination and corneal topography, a diagnosis of pellucid marginal degeneration and cataract was made. Since visual acuity and refraction had been stable in the past 3 years, the patient underwent cataract extraction and implantation of a custom-designed toric posterior chamber intraocular lens. Postoperative follow-up of 1.5-year demons- trated marked improvement in visual acuity, stable refraction and patient satisfaction. This treatment for pellucid marginal degeneration offers the simplicity of regular cataract surgery, and avoids the known complications of keratoplasty and other corneal surgical manipulation for the management of pellucid marginal degeneration. How to cite this article Bahar I, Bialer O. Cataract Extraction and Toric Intraocular Lens Implantation for the Management of Pellucid Marginal Degeneration and Cataract. Int J Keratoco Ectatic Corneal Dis 2012;1(1):66-67.

Current concepts and techniques in corneal transplantation.

The corneal endothelium is the most important single layer in corneal transplantation. In his Castroviejo Lecture, William Bourne, MD, summarizes his work on the corneal endothelium and its importance to corneal transplantation. Almost half the corneal transplants performed in the United States are done so because of malfunctioning, diseased, or absent endothelial cells. If just this layer could be transplanted, the long wait for better vision after keratoplasty (up to two years in some countries) can be eliminated, as well as the problems of epithelial and subepithelial graft rejection. The significant astigmatism after keratoplasty could also be reduced. Transplantation of the endothelium in deep lamellar keratoplasty is being done in limited fashion throughout the world and the first patients have now been done in the United States. In many countries where corneal tissue is difficult to obtain, keratoplasty is only performed on one eye, even though both eyes may need it. One article this year discusses binocular vision recovery in bilateral keratoplasty and the objective and subjective improvements after bilateral keratoplasty. Patients who are bilaterally blind from diseases such as Stevens-Johnson syndrome, and ocular pemphigoid have little hope of visual recovery from conventional corneal transplants. The use of a keratoprosthesis to bypass the totally abnormal conjunctival surface has helped many people in the past. The preoperative prognostic categories of patients who may benefit from keratoprosthesis has been carefully reviewed in a large number of keratoprosthesis patients and this information will help ophthalmologists decide who will benefit the most benefit from keratoprosthesis. This year, articles on corneal transplantation after conjunctival flaps, suture-related complications in keratoplasty, the implantation of an intraocular lens after penetrating keratoplasty, and long-term results of penetrating keratoplasty with glaucoma drainage tube implants are subjects that warrant in depth discussion and evaluation. Finally, eye bank considerations will be discussed concerning the long-term question of transmission of cancer through corneal transplantation.

Complications of Keratoplasty: The Gifford Lecture

The complications of keratoplasty have been greatly reduced in recent years by virtue of finer instrumentation, microsurgery, new drugs to minimize postoperative complications, and improved methods of donor cornea preversation. A 49-year-old woman, following uncomplicated keratoplasty with donor material from a patient who had died of a slow virus disease, developed the same condition and died 18 months later. Until more evidence is available, donor material from individuals dying of obscure chronic central nervous system disorders should be used with extreme caution.

The paretic pupil: its incidence and aetiology after keratoplasty for keratoconus.

The present study reveals that pupillary abnormalities are common after keratoplasty for keratoconus and that, in addition to the fixed dilated pupils which we have found in 7.8 per cent. of eyes, varying degrees of partially dilated pupil frequently occur after operation. In our experience, glaucoma is not a sequel to the simple paretic pupil, a finding which confirms the results of the smaller series of Alberth and Schnitzler (1971); glaucoma thus seems to be no more a special complication of keratoplasty for keratoconus than it is of keratoplasty for any other corneal pathology. The paretic pupils can be explained on the basis of ischaemic atrophy of the sphincter pupillae muscle secondary to an iris strangulation phenomenon occurring during surgery in the manner we have discussed. The relative frequency of a dilated pupil, together with the common finding of focal iris atrophy after minimal surgical trauma to the iris in cases of keratoconus, forces one to conclude that the pathology in this condition is not confined to the cornea but probably extends to the iris and possibly to the scleral envelope as well.

Pathogenesis of the retrocorneal membrane.

A compilation of three histolopathologic studies of corneal graft specimens shows that approximately 50% of opaque grafts have retrocorneal membranes, ie, connective tissue extending from the wound behind the Descemet's membrane.1-3This postoperative complication of keratoplasty was first described in 1901 by Fuchs, who felt that iritis was the factor responsible for its development.4 Since this report by Fuchs, there have been numerous statements in the literature as to the cause of this so-called retrocorneal membrane (Table).5-11The great majority was based on clinical observations or histologic examinations after the development of the complication. Laboratory investigations aimed specifically at determining the cause and development of the retrocorneal membrane are few. In 1957, Leigh8mentioned that a retrocorneal membrane developed behind a graft from which one half of the endothelium had been removed, and it was in this area that the membrane developed. In 1963, Bushmitch and

Prevention and Management of Early and Late Complications of Keratoplasty : (Penetrating and Lamellar): An Analysis of 120 Consecutive Cases

Prevention and Management of Early and Late Complications of Keratoplasty : (Penetrating and Lamellar): An Analysis of 120 Consecutive Cases

Clinical evaluation of the precipitin test in the postoperative course of keratoplasty.

In 1914, Friedberg 1 observed a virulent inflammation in the host tissue surrounding an implant 14 days postoperatively and inferred from this observation that the serological relationship played a role in graft healing. The inflammation, which was rapidly reduced, was tentatively interpreted as an anaphylactic reaction. Following this report, and especially recently, many authors, such as Muller and Maumenee, 2-4 Choyce 5 Babel and Bourquin, 6 Maumenee, 7 Morawiecki, 8 Basu and Ormsby, 9,10 Kornblueth, 11 Lieb and Lerman, 12 Kamata, 13 and Arai, 14,15 have recognized an antigen-antibody reaction after homo- and heterocorneal grafting. Postoperative graft opacity—the most unhappy complication of keratoplasty for the surgeon as well as the patient—may have a variety of causes. In 1948, Paufique, Sourdille, and Offretin 16 applied the term maladie du greffon to the opacity that arose inexplicably without manifest operative complications. Local allergy was regarded as one of the most important causal factors,