Cases Of Keratoplasty Research Articles

Penetrating keratoplasty from a temporal approach

PURPOSE: To describe the technique of penetrating keratoplasty using a temporal approach. METHODS: Report of two cases of phakic penetrating keratoplasty performed with the surgeon positioned at the temporal side of the head. RESULTS: The temporal approach improved the surgical exposure, which eliminated the need for a bridal suture, facilitated the placement of the first two cardinal sutures, and facilitated subsequent placement of nasal sutures. CONCLUSION: The temporal approach to penetrating keratoplasty may facilitate suture placement, decrease surgical time, and reduce suture-induced astigmatism.

Therapeutic Keratoplasty Using Preserved Corneas From Keratoconus Eyes

Purpose: To report and discuss cases of lamellar keratoplasty using corneas obtained during previous penetrating keratoplasty in keratoconus eyes. Methods: Corneal buttons were obtained from 7 keratoconus patients and stored in a preserving solution for 7–60 days (average, 32.4 days) before use. The recipient eyes comprised recurrent pterygium 3 eyes, primary pterygium 1 eye, pseudopterygium 1 eye, corneal perforation with iris prolapse due to fungal corneal ulcer 1 eye, and limbal dermoid 1 eye. Results: The recipient eyes ran favorable courses in general. Graft rejection developed in 2 eyes and was successfully treated with topical and systemic corticosteroid. Conclusions: Preserved corneas from keratoconus eyes were found useful in therapeutic lamellar keratoplasty. By this procedure, the current inadequate supply of donor corneas in eye banks in Japan can be augmented.

Risk factors for graft failure in penetrating keratoplasty.

We clarified the preoperative risk factors for graft failure in penetrating keratoplasty with fresh donor corneas. This analysis covered 698 consecutive keratoplasty cases in a single center between 1971 and 1992, and was designed to assess the risk factors. The risk factors in penetrating keratoplasty were determined by the Cox multiple regression model which considers the follow-up periods and multiple factors simultaneously. The factors which worsen the prognosis of keratoplasty significantly were found to be preoperative endothelial dysfunction (hazard ratio = 2.3), prior glaucoma/ocular hypertension (hazard ratio = 2.0), preoperative corneal vascularization (hazard ratio for within one quadrant = 1.3, hazard ratio for 2 or more quadrants = 1.6), anterior synechiae of iris (hazard ratio = 1.5), aphakia or pseudophakia (hazard ratio = 1.4), and older donor age (hazard ratio = 1.3 in proportion to the increase of each 10-year period of age). Surgeons must take these risk factors into consideration to obtain a better prognosis for keratoplasty.

Penetrating Keratoplasty In Xeroderma Pigmentosum

Xeroderma pigmentosum is an uncommon inherited disorder characterized by hypersensitivity to ultraviolet radiation, with defective repair of DNA damage caused by short-wavelength radiation. Corneal complications of this disorder may require penetrating keratoplasty for visual rehabilitation. Surgery is rarely undertaken in these eyes due to multiple associated problems involving the ocular surface and the lids. We report three cases of successful penetrating keratoplasty in xeroderma pigmentosum and review nine cases reported earlier. Successful grafts were achieved in all 12 eyes initially. Persistent superficial punctate keratopathy was observed in one eye and graft rejection episodes in five eyes. However, graft failure occurred due to an untreated rejection episode in only one eye. Another eye was treated by exenteration for recurrent ocular malignancies. This report highlights the encouraging results of penetrating keratoplasty in carefully selected patients of xeroderma pigmentosum with corneal pathology.

Penetrating keratoplasty and cataract surgery: the advantages of an extracapsular technique combined with posterior chamber intraocular implantation.

The results of 28 consecutive triple procedures and 33 cases of combined penetrating keratoplasty and extracapsular extraction are presented. All the eyes with the triple procedure maintained a clear graft; 77 per cent achieved an acuity of 6/12 or better. The average time before a refractive correction could be dispensed was 8.2 months, while after a combined procedure the interval was 17.4 months, although in both groups the average time until the best visual acuity was reached was similar.

Glaucoma Associated with Penetrating Keratoplasty

The occurrence of chronic postoperative glaucoma in 502 consecutive penetrating keratoplasty cases performed in 421 patients during 1978 through 1986 was 18% (91 cases). Immediate postoperative glaucoma occurred in 9% (44 cases) and progressive angle closure occurred in 2% (13 cases) of keratoplasties. Statistically significant risk factors for development of glaucoma were preexisting glaucoma and aphakia. The type of cataract extraction, use of an intraocular lens, or performance of vitrectomy did not pose significant risk of glaucoma. Surgical therapy of glaucoma was required in 24% of those with glaucoma and was most effective as cyclodestructive surgery especially in patients with progressive angle-closure glaucoma.

Nontransmission of HIV in Four Cases of Keratoplasty with Two HIV-Infected Donors

Nontransmission of HIV in Four Cases of Keratoplasty with Two HIV-Infected Donors

Hurricane Keratitis in Penetrating Keratoplasty

A characteristic “hurricane”-shaped epithelial keratitis was seen in 15 cases of recent penetrating keratoplasty. The keratitis appeared to be caused by the use of Maxitrol. The pattern of the keratitis was believed to be a manifestation of the normal healing pattern of the corneal epithelium. The fact that the toxicity reported here appeared only in grafted corneas indicates that the epithelium of the corneal graft is highly sensitive to topical medications. Therefore, this pattern might be expected to be seen with the use of other epithelial toxic drugs.

Combined Keratoplasty, Cataract Extraction, and Intraocular Lens Implantation: Experience at the Wilmer Institute

A review of 12 cases of combined keratoplasty, cataract extraction and IOL implantation performed during the past five years at the Wilmer Institute is presented. The results show 80% of cases with 6/12 (20/40) vision or better with a follow-up of at least six months. All but one of the grafts remained clear. Our current technique for keratoplasty, extracapsular cataract extraction and posterior-chamber IOL implantation is described. This technique has several advantages, including the following: an intact posterior capsule, no anterior vitrectomy, protection of the cornea from the IOL by the iris, and potential for full pupil dilation after surgery. Conservative and highly selective use of the procedure is recommended.

Combined penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber lens implantation.

A retrospective chart review of 18 consecutive unselected cases of combined penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber lens implantation was performed. Overall, 89% of the grafts remained clear with follow-up between six and 54 months (average 21 months). Visual acuities were 20/50 or better in 61% of the cases and 20/80 or better in 83%. Postoperative complications included two graft failures, two cases of secondary glaucoma, one case of cystoid macular edema, and one case of pupil capture. No patients to date have required a secondary discission.

Histocompatibility (Hla) Antigens and Keratoplasty

In 84 cases of keratoplasty, all patients had densely vascularized corneas and a history of prior exposure to HLA antigens by pregnancy, blood transfusion, or previous transplantation. Donors were selected on the basis of a negative crossmatch to avoid donor antigens to which the recipient was preimmunized. The overall rate of graft failure from rejection was 15%. A retrospective analysis of donor-recipient HLA matching in 103 high-risk cases showed no consistent correlation between the number of antigens shared and graft outcome. These findings indicated negative cross-match to be important in donor selection for keratoplasty in high-risk cases.

Immunological investigations of patients with transplanted cornea.

Authors examined the role of the cellular immunity by the method (I) of lymphoblastic transformation in 26 keratoplasty cases. Only in one case did they observe significant blast transformation, in this case the keratoplasty was necessary after injury with lime. In the rest of the cases no positive result were ever obtained. They investigated the cellular immunoreactivity of 10 patients waiting for keratoplasty and 10 cataractous patients against cornea antigen by means (II) of the Leucocyte Migration Test (LMT). The change of the cellular immuno-reactivity against cornea antigen was examined on the 1st, 4th, 7th, 14th, 21st, and 28th days after keratoplasty. It could be established that after keratoplasty the LMT became positive (inhibition or stimulation of migration). The results of the LMT investigations obtained on keratoplasty patients by cornea antigen may be of some help for the understanding of the events in the postoperative phase and sometimes also may eventually require immunosuppressive therapy.

Keratoplasty. Results using donor tissue beyond 48 hours.

A retrospective study-report on 145 penetrating keratoplasty cases is presented. The donor tissue came from the United States, and the transplantation took place in Beirut, Lebanon, 50 to 72 hours after excision. The corneas belonged to donors 50 to 85 years of age. The preoperative vision in the recipient eye ranged from light perception to 20/100, and the postoperative vision in 83% of the cases ranged from 20/20 to 20/50. One can conclude that corneas more than 50 hours old and from elderly donors are dependable for use in penetrating keratoplasties.