Indication For Corneal Transplantation Research Articles

Indications for corneal transplantation in Thailand between 1996 and 2008

Background: Corneal transplantation is the most frequent organ transplantation worldwide. Many indications for corneal transplantation have been proposed and several novel indications have been reported in various studies. Nevertheless, there is no national data from Thailand to date. Objective: We identified indications and evolving trends of corneal transplantations in Thailand between January 1996 and December 2008 Methods: Corneal graft registry records of the Thai Red Cross Eye Bank during January 1996 and December 2008 were retrospectively reviewed. Diagnosis of the recipient eye is considered as an indication for transplantation. Patients’ demographic data, diagnosis, operating hospitals, and number of collected corneal tissues annually were collected. Analyzed data were shown in scattergram and simple linear regression. A p value of 0.05 was considered significant. Results: Among 3,582 records, 2,802 (78.2%) had the transplantation done for an optical reason. Others were performed due to either therapeutic or tectonic reasons. None of the cases was operated for a cosmetic concern. Mean age of patients was 51.8 years. Male (56.7%) was slightly predominant over female (43.2%). Corneal scar (20.44%) was the most frequent indicated reasons followed by corneal ulcer (19.15%), pseudophakic and aphakic bullous keratopathy (16.81%), corneal dystrophies (11.08%) and regraft (10.75%). PBK/ABK and regraft showed an increasing trend during the study period. Conclusion: Common indications for corneal transplantation in Thailand were corneal scar, corneal ulcer, PBK/ABK, corneal dystrophies and regraft respectively. Due to imbalanced demand and supply of donated corneas, not all of the patients received corneal transplantations in a timely manner. As a result, this study might not truly represent the actual indications for corneal transplantation in Thailand. With continued development in donation awareness, financial support and inter-organizational collaborations and healthcare as a whole, adequate numbers of corneal supply might be possible in the future. Keywords: Corneal transplantation, indication, penetrating keratoplasty

Corneal transplantation in Hungary (1946-2009)

To identify changing trends in indications for corneal transplantation in Debrecen, Hungary over the past 64 years. Retrospective study, at the Department of Ophthalmology, University of Debrecen, Hungary. Four thousand seven hundred and seventy-eight patients who underwent keratoplasty. The analysis was based on medical charts, surgical descriptions and eye bank records. Keratoplasty indications between January 1946 and December 2009. For an easier overview, the 64-year interval was divided into seven time periods (1946-1955, I; 1956-1965, II; 1966-1975, III; 1976-1985, IV; 1986-1995, V; 1996-2005, VI; 2006-2009, VII). Over the 64 years, clinical indications for keratoplasty were corneal scarring (24.9%), regraft (18.6%), keratoconus (18.6%), pseudophakic/aphakic corneal oedema (12%), stromal corneal dystrophies (6%), non-infectious keratitis (4.7%), chemical injuries (3.3%), corneal degenerations (3%), mechanical trauma (1.7%), infectious keratitis (1.4%), endothelial corneal dystrophies (1.3%) and others (4.5%). During periods I-IV, corneal scarring was the most common indication for corneal transplantation. In period V, corneal ectasia became the leading clinical indication. Regraft was the most frequent indication in period VI. In the most recent years, an emerging tendency in pseudophakic/aphakic corneal oedema as the indication for keratoplasty was observed. In Hungary, the number of grafts has increased greatly in the past 64 years, the transplantation rates are similar to those of industrial countries. Indications for corneal transplantation have changed considerably over the last half decade from corneal scarring to corneal ectasia, regraft and pseudophakic/aphakic corneal oedema.

Descemet’s Stripping Automated Endothelial Keratoplasty

Taken together, causes of endothelial decompensation represent a major indication for corneal transplantation. Posterior lamellar grafts allow patients with endothelial failure to avoid many of the complications associated with the full thickness penetrating keratoplasty. Evolving over the last decade, Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) represents the latest incarnation of posterior lamellar grafting techniques. This article contains four case reports from the cornea clinic where the author is a resident, and a review of literature highlighting the benefits of posterior lamellar grafting.

Corneal Innervation and Cellular Changes after Corneal Transplantation: An In Vivo Confocal Microscopy Study

Although penetrating keratoplasty is generally considered a successful procedure, transplanted corneal tissue may exhibit abnormal epithelium, decreased sensation, and declining endothelial cell counts after surgery. This study aimed to use in vivo confocal microscopy to correlate corneal microstructure and recovery of the subbasal nerve plexus of the transplanted cornea with indications for, and time from, surgery. This was a cross-sectional study comparing corneas from 42 patients after penetrating keratoplasty with those of 30 controls. Subjects were assessed by ophthalmic history and clinical examination, computerized corneal topography, and laser scanning in vivo confocal microscopy. Time from surgery ranged from 1 month to 40 years (mean, 85 +/- 105 months). Significant reductions in epithelial (P < 0.001), keratocyte (P < 0.001), and endothelial (P < 0.001) cell densities were noted in comparison with control corneas. Significant reductions in subbasal nerve fiber density (P < 0.001) and nerve branching (P < 0.001) were also noted. Endothelial cell density decreased with time after surgery (r = -0.472; P = 0.003), and nerve fiber density (r = .328; P = 0.034) increased. Keratoconus as an indication for transplantation was associated with higher subbasal nerve fiber densities (P = 0.003) than other indications for corneal transplantation. Neither nerve fiber nor cell density was correlated with best-corrected visual acuity. Laser scanning in vivo confocal microscopy highlights profound reductions in cell density at every level of the transplanted cornea and alterations to the subbasal plexus that are still apparent up to 40 years after penetrating keratoplasty.

Surgical treatment of corneal pathology in patients with Down's syndrome.

Keratoconus is a major cause of blindness in patients with Down's syndrome. A retrospective study of 30 corneal grafts for keratoconus in these patients revealed a 5-year graft survival of 67%. Postoperative trauma and/or infection was the main cause for graft failure. Conditions that should be met before the indication for corneal transplantation in a patient with Down's syndrome are formulated as a result of 15 years experience with that patient population. In appropriate cases, corneal transplantation may undoubtedly improve the quality of life in these patients.

A SIMPLE TECHNIC FOR CORNEAL TRANSPLANTATION

The history of and indications for corneal transplantation have been well covered in the European literature by Filatov and Tudor Thomas and in the literature of this country by Castroviejo. Those particularly interested in this subject will find comprehensive information in Castroviejo's articles. However, my colleagues and I have the impression that many ophthalmic surgeons fear to do a corneal transplantation because the technic appears too com