Corneal Transplantation For Keratoconus Research Articles

Corneal transplantation for keratoconus in South Korea

This nationwide population-based study investigated the incidence rate of and risk factors for the progression to corneal transplantation in patients with keratoconus in South Korea using claims data from the Health Insurance Review and Assessment service. Among the entire South Korean population, 10,612 patients newly diagnosed with keratoconus between January 2010 and June 2015 were identified and included in the study. During the study period, 124 patients (1.17%) underwent corneal transplantation, with an average follow-up period of 2.97 ± 1.59 years. The incidence rate of corneal transplantation in patients with keratoconus was 4.46 cases per 1000 person-years. The rate of corneal transplantation for keratoconus was relatively low in South Korea compared to other countries. Multivariate Cox regression analysis revealed that male sex (HR 2.37; 95% CI 1.61–3.50; P < 0.001), severe atopic dermatitis (HR 2.32; 95% CI 1.02–5.28; P = 0.044), obstructive sleep apnea (HR 9.78; 95% CI 1.36–70.10; P = 0.023), and intellectual disability (HR 4.48; 95% CI 1.33–15.11; P = 0.016) significantly increased the risk of progression to corneal transplantation. In patients with keratoconus, male sex, severe atopic dermatitis, obstructive sleep apnea, and intellectual disability were associated with an increased risk of corneal transplantation.

Keratokonusas: 14-kos metų kiaurinės keratoplastikos ankstyvųjų pooperacinių rezultatų apžvalga

Keratokonusas – viena dažniausių kiaurinės keratoplastikos (KKP) priežasčių pasaulyje. Serga jauni, darbingo amžiaus žmonės, todėl pažengus ligai (vėlyvoje stadijoje), kai kiti gydymo metodai neefektyvūs, KKP gali grąžinti regą. Pastebėta, kad po donorinės ragenos persodinimo komplikacijų pasitaiko, tačiau dauguma recipientų patenkinti pooperaciniu rezultatu. Siekdami įvertinti dėl keratokonuso atliekamų KKP dažnį išanalizavome per 14-lika metų (2001-2014 m.) LSMUL KK Akių ligų klinikoje operuotų ligonių atvejus. Šiame straipsnyje aptarsime KKP dažnį, kai donorinės ragenos persodinimo priežastis - keratokonusas, sergančiųjų pasiskirstymą pagal amžių, lytį, pažeistą akį, taip pat ankstyvuosius pooperacinius rezultatus (regos aštrumo pokytį, pooperacinę eigą, komplikacijas), kataraktos ir glaukomos bei amžiaus reiškmę regos aštrumo pokyčiui. Retrospektyvinis tyrimas vykdytas gavus Bioetikos centro leidimą (Nr. BEC-MF-623). Nustatyta, kad 2001-2014 metais KKP dėl keratokonuso atlikta 71 akyje (24,83 proc.). 59 recipientams persodinta donorinė ragena vienoje akyje, 6 – abiejose akyse. Transplantacijų pasiskirstymas pagal pažeistą akį statistiškai reikšmingai nesiskiria (p=0,635): dešinės akies keratoplastika - 33 ligoniams (46,5 proc.), kairės – 38 ligoniams (53,5 proc.). 19 (26,8%) moterų, kurių amžiaus mediana 39 (27-46) metai ir 52 (73,2%) vyrai, amžiaus mediana 28,5 (25-36) metai. Imtyje vyrų buvo statistiškai reikšmingai daugiau nei moterų (p&amp;lt;0,001). Vyrų ir moterų amžius statistiškai reikšmingai skiriasi (p &amp;lt; 0,019). Nustatyta, kad po ragenos persodinimo 95,8 proc. recipientų regos aštrumas pagerėjo: nežymiai – 32,4 proc., vidutiniškai – 50,7 proc., ženkliai – 12,7 proc. Tik 4,2 proc. recipientų regos aštrumas nepakito ar net pablogėjo. Sklandi pooperacinė eiga (be užfiksuotų komplikacijų) buvo 40 (56,3 proc.) recipientų. 31 tiriamajam (43,7 proc.) stebėtos įvairios komplikacijos. Iš viso diagnozuoti 58 komplikacijų atvejai: 21 recipientui nustatyta viena iš komplikacijų, likusiems - dvi ir daugiau. Ragenos atmetimo reakcija – 14 (24,1proc.) recipientų, ragenos paburkimas – 13 (22,5 proc.) recipientų, siūlės (-lių) atsipalaidavimas – 12 (20,7 proc.) recipientų, akispūdžio padidėjimas – 8 (13,8 proc.) recipientų, transplantato vaskuliarizacija – 5 (8,6 proc.) recipientams, descemeto membranos raukšlės – 4 (6,9 proc.) recipientams, infiltracija apie siūles – 2 (3,4 proc.) recipientams. 2001-2014 metais LSMUL KK Akių ligų klinikoje 24,8 proc. KKP operacijų atlikta dėl keratokonuso. KKP dešinėje ir kairėje akyse atliktos vienodai dažnai (46,5 proc. v.s. 53,5 proc., p&gt;0,635). Donorinės ragenos persodinimo operacija dėl keratokonuso dažniau taikyta vyrams nei moterims (73,2proc. vs. 26,8 proc., p&amp;lt;0,001) ir atlikta 10,5 metų jaunesniame amžiuje (p&amp;lt;0,019). Po kiaurinės keratoplastikos 95,8 proc. atvejų regos aštrumas pagerėjo ir tik 4,2 proc. nepakito, ar net pablogėjo. Jokių komplikacijų nebuvo 40 (56,3 proc.) recipientų. Dažniausia komplikacija - ragenos atmetimo reakcija (24,1 proc.).

Photorefractive keratectomy with mitomycin-C after corneal transplantation for keratoconus

Photorefractive keratectomy with mitomycin-C after corneal transplantation for keratoconus

Photorefractive keratectomy with mitomycin-C after corneal transplantation for keratoconus

To evaluate the efficacy of photorefractive keratectomy (PRK) for residual refractive error after penetrating keratoplasty (PKP) for keratoconus. Private ophthalmic clinic. Case series. Consecutive patients who had PRK augmented with topical mitomycin-C (MMC) after PKP for keratoconus were retrospectively reviewed. Patients were divided into a a low cylinder group (refractive cylinder ≤ 6.00 D) and a high cylinder group (refractive cylinder >6.00 D). Visual acuity, refraction, and keratometry were analyzed preoperatively and 1, 3, 6, and 12 months postoperatively. The study comprised 47 eyes (41 patients). The spherical equivalent (SE) decreased from -4.24 D ± 3.23 (SD) preoperatively to -0.71 ± 1.03 D 12 months postoperatively in the low cylinder group and from -4.19 ± 3.54 D to -2.45 ± 3.42 D, respectively, in the high cylinder group. The refractive cylinder decreased from -4.27 ± 1.4 D to -1.71 ± 1.55 D, respectively, in the low cylinder group and from -7.78 ± 1.21 D to -4.6 ± 2.54 D, respectively, in the high cylinder group. By the last follow-up, 8.3% of patients had lost 2 lines of corrected distance visual acuity. There were no cases of corneal haze greater than 2+ or of graft rejection. Penetrating keratoplasty with adjunctive MMC decreased several refractive variables in patients with previous PKP. These results compare well with those in the published literature and suggest PRK is as effective as, and probably safer than, laser in situ keratomileusis in treating refractive error in these cases. No author has financial or proprietary interests in any material or method mentioned.

Comparison of Three Different Techniques of Corneal Transplantation for Keratoconus

Comparison of Three Different Techniques of Corneal Transplantation for Keratoconus

Risk Factors for the First Episode of Corneal Graft Rejection in Keratoconus

To evaluate the relationship between topical corticosteroids and other variables and the risk for rejection after penetrating keratoplasty for keratoconus. The records of all keratoconus patients who, after their first penetrating keratoplasty in that eye, experienced a first episode of corneal graft rejection during a specific 3-year period were retrospectively reviewed in a case-control fashion. Twenty-three cases were identified, and they were matched with 3 controls each, for a total of 69 controls and 92 total patients. Multiple variables including steroid potency, recent steroid tapering, and length of time on the current level of steroids were analyzed to see whether there were any significant relationships between postoperative changes in steroid management and rejection. In addition, other variables such as graft size, suture technique, recent suture removal, suture status at the time of the rejection episode, and prior grafting in the fellow eye were examined to determine if any of these factors were associated with a higher risk of graft rejection. Most of the proposed risk factors, including steroid dose and tapering, differing suturing techniques, loose and/or broken sutures at the time of rejection, percentage of sutures remaining at the time of rejection, and prior grafting in the fellow eye, did not correlate with the risk of rejection. Only graft size had a correlation, with host trephination size > or = 8.25 mm having a nearly sixfold increased risk of rejection (P = 0.015). Most patients (70%) were diagnosed with rejection at a scheduled office visit rather than at an emergency visit, and correspondingly, nearly one half (43%) had no symptoms when rejection was identified. There was no significant difference in final best-corrected visual acuities between the cases and controls, and 91% of the corneas that underwent rejection did not progress to graft failure, remaining centrally clear at most recent follow-up. In this study, the most important risk factor for rejection after corneal transplantation for keratoconus was the size of the graft. Physician detection of rejection is paramount, because a graft rejection episode is more often diagnosed at a scheduled office visit than at an emergency visit. Fortunately, progression to graft failure can usually be prevented if treatment is started promptly and intensively.

Laser in situ keratomileusis to correct myopia, hypermetropia and astigmatism after penetrating keratoplasty for keratoconus: a series of 27 cases

Background: Excimer laser treatment has been shown to be effective and safe in correcting anisometropia following penetrating keratoplasty (PKP). In this report we review our experience with excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, hypermetropia and astigmatism in patients who had undergone PKP for keratoconus.Methods: We reviewed the records of 22 patients (27 eyes) who had undergone LASIK to correct myopia, hypermetropia or astigmatism, in simple or combined forms, following corneal transplantation for keratoconus. LASIK was performed at a hospital in Curitiba, Brazil, between September 1998 and February 2000. The eyes were classified into two groups: those with a negative spherical equivalent and those with a positive spherical equivalent. LASIK was performed using the Moria LSK microkeratome and the Nidek EC-5000 excimer laser.Results: The mean length of follow-up was 9.52 months for the 23 eyes with myopia and 5.75 months for the 4 eyes with hypermetropia. The mean refractive spherical equivalent in the myopic eyes was −5.27 (standard deviation [SD] 1.91) dioptres before LASIK and −0.45 D (SD 1.68 D) at the last follow-up visit. The corresponding values in the eyes with hypermetropia were +5.18 D (SD 1.46 D) and + 1. 18 D (SD 0.94 D). The rate of regression of astigmatism in the myopic eyes was 76%. After surgery 18 (78%) of the myopic eyes and all the hypermetropic eyes had an uncorrected visual acuity of 20/40 or better. The best spectacle-corrected visual acuity was better than 20/25 in 22 (95.7%) of the myopic eyes and all the hypermetropic eyes. One eye lost I line of best spectacle-corrected Snellen visual acuity, and one eye lost 6 lines secondary to epithelial ingrowth. Wound dehiscence, intraoperative flap complications, graft rejection or other complications did not develop in this series.Interprétation: In this series, LASIK proved to be relatively safe and effective in correcting refractive errors after PKP for keratoconus.

Pellucid Marginal Cornet Degeneration 12 years After Penetrating Keratoplaty for Keratocomes

To report visually disabling postkeratoplasty astigmatism occurring 12 years after a corneal transplant for keratoconus apparently caused by pellucid marginal corneal degeneration (PMD). A 33-year-old woman had had a corneal transplant for keratoconus in her left eye. Twelve years later, she was referred for evaluation and management of increasingly blurred vision due to marked postkeratoplasty astigmatism. The donor cornea protruded over a region of thinning, anterior to and concentric with a thinned inferior wound. Videokeratoscopy showed +18.35 D of astigmatism in the 34 degree meridian and inferior corneal steepness surrounding the region of inferior flatness. To our knowledge, this is the first case of apparent PMD occurring after corneal transplantation for keratoconus. The presence of subtle biomicroscopic and keratoscopic signs of PMD prior to corneal transplantation for keratoconus may affect the planned surgical approach.

Corneal transplant for keratoconus: Results in early and late disease

Purpose: To evaluate the results and complication rates associated with corneal transplantation for keratoconus and assess the prospects of using penetrating keratoplasty at a much earlier stage.Setting: Buzard Eye Institute, Las Vegas, Nevada, USA.Methods: In this prospective clinical study, 104 eyes of 76 patients had corneal transplantation for keratoconus identified by corneal topography, keratometry, pachymetry, and/or retinoscopy. Sutures were removed at a mean of 15 months; mean follow-up was 42 months. All surgeries were performed by one surgeon using a torque-antitorque suture method. Eyes were grouped according to severity of the disease: early (n = 24); moderate (n = 47); high (n = 33). Preoperative keratometry was 40.00 to 49.00, 50.00 to 59.00, and 60.00 to 90.00 diopters (D), respectively. The criteria for corneal transplant were a best spectacle-corrected visual acuity of 20/40 or worse and keratoconus clearly identified by one of the above methods. Secondary procedures included repair of wound dehiscence (33 eyes, 31%), relaxing incisions (33 eyes, 31%), wedge resections (5 eyes, 5%), and automated lamellar keratoplasty (4 eyes, 4%).Results: Mean postoperative uncorrected visual acuity at last follow-up was 0.43 ± 0.3 (20/50), with 46 eyes (44%) achieving 20/40 or better. Mean best corrected visual acuity (BCVA) at last follow-up was 0.83 ± 0.2 (20/25). Sixty eyes (58%) achieved 20/40 or better BCVA at 1 month and 92 eyes (88%), at 3 months. At last follow-up, mean average keratometric astigmatism was 3.10 ± 1.70 D, mean keratometry was 43.30 ± 2.20 D, and mean spherical equivalent was -1.70 ± 3.00 D. Complications included 21 graft rejections (20%); 19 were successfully treated with topical and oral steroids. No expulsive hemorrhage or endophthalmitis occurred.Conclusion: The risk-benefit ratio for corneal transplantation has been significantly altered by improved surgical and postoperative techniques. The improved results, low complication rate, and postoperative enhancement management indicate that corneal transplantation is a viable option early in the clinical course of keratoconus.