Time Of Penetrating Keratoplasty Research Articles

The presence and impact of herpes virus DNA in recipient cornea and aqueous humor on graft survival following penetrating keratoplasty

Reactivation of herpes viruses poses threat to corneal graft survival. This study evaluated the presence of herpes simplex virus type 1 (HSV-1), HSV type 2 (HSV-2), and cytomegalovirus (CMV) DNA in recipient corneas and the aqueous humor of patients undergoing penetrating keratoplasty (PKP), and the impact on graft survival. This retrospective study reviewed 90 eyes of 71 patients underwent PKP between 2008 and 2016. Cornea and aqueous humor samples were sent for polymerase chain reaction (PCR) testing for viral DNA. The main outcomes were PCR results and graft survival. Recipient corneas tested positive for HSV-1 in 47 eyes (52.2%), for HSV-2 in 24 eyes (26.7%), and for CMV in seven eyes (7.8%). Aqueous humor tested positive for HSV-1 in 44 eyes (48.9%), for HSV-2 in 25 eyes (27.8%), and for CMV in eight eyes (8.9%). The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure (p=0.005), whereas corneal HSV-1 DNA was not. The presence of HSV-2 DNA had no significant impact on graft survival. Aqueous CMV DNA was associated with higher risk of graft failure in univariate model, but not in multivariate model. There were high positive rates of HSV-1, HSV-2, and CMV DNA in recipient corneas and aqueous humor at the time of PKP, even among patients not suspected of latent viral infection. The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure.

Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus

Background/AimTo review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).MethodsWe reviewed the medical records of 53 eyes of 53 patients who underwent PKP...

Iris Reconstruction in Penetrating Keratoplasty—Surgical Techniques and a Case-control Study to Evaluate Effect on Graft Survival

To demonstrate techniques of iris reconstruction (pupilloplasty) at the time of penetrating keratoplasty (PKP) for a variety of pupil abnormalities, and to evaluate the effect of pupilloplasty on graft survival and visual outcome. Case-control study. Thirty-five cases (combined PKP and pupilloplasty) and 70 controls (PKP alone) were included. Various pupil abnormalities and the surgical techniques used to correct them were reviewed and categorized. The Chi-square and Student t tests were used to compare the baseline risk factors and demographic variables between treatment and control groups. The known risk factors for corneal graft survival were analyzed by Kaplan-Meier and Cox regression methods. Twenty men and 15 women in the age range, 27 to 77 years underwent combined iris reconstruction and PKP with pseudophakic/aphakic bullous keratopathy being the most common indication. The mean follow-up duration was 39.12 months and eight (22.9%) grafts failed during follow-up. Iris reconstruction during PKP has a significant positive effect on long-term graft survival (hazard ratio 2.52; 95% CI, 1.14 to 5.57; P = .022). Patients with pupilloplasty also tended to have a better mean postoperative visual acuity compared to the control group (P = .40). Iris reconstruction is a relatively simple procedure that should be performed in eyes with substantial pupil abnormalities at the time of PKP. Pupilloplasty significantly improves graft survival, renders the pupil cosmetically more acceptable, and may improve visual outcome.

Penetrating keratoplasty for endothelial decompensation in eyes with buphthalmos.

To evaluate the prognosis and complications of penetrating keratoplasty (PKP) for corneal decompensation in eyes with buphthalmos and to analyze the risk factors for graft failure. Clinical records of 13 adult and three pediatric patients who underwent PKP for endothelial decompensation with a previous diagnosis of congenital glaucoma of a total of 3,663 corneal transplantations performed in our department between January 1987 and December 2001 were reviewed retrospectively. During the study period, a total of 33 PKPs was performed in 20 eyes with buphthalmos. The median age of the patients at the time of PKP was 39 years (range, 3 to 72). All patients had a history of intraocular surgery, including multiple glaucoma surgeries, cataract extraction, and PKP. The impact of pre-, intra-, and postoperative factors on graft failure and duration of graft clarity was analyzed. Fifty-five percent (11/20) of the eyes received only one graft, 25% (5/20) received two, and 20% (4/20) received three grafts. During a mean follow-up of 87.2 months (range, 4.5-72), graft failure occurred in 18 of 33 grafts (54%). Seven (7/18, 39%) had immunologic graft rejection, and 11 (11/18, 61%) had nonimmunologic graft failure. At the end of the follow-up, 75% (15/20) of the eyes had clear grafts. Duration of graft clarity was found to be significantly shorter in regrafts compared with that of primary grafts (27.0 +/- 27.7 versus 56.4 +/- 41.0 months, p= 0.02). After PKP, intraocular pressure (IOP) was uncontrolled in 12 (12/33, 36%) grafts. Nine of 20 eyes (45%) required an average of 3.2 cyclodestructive procedures per eye for pharmacologically resistant elevated IOP. The final postoperative vision improved in 70% (14/20) of the eyes and the best visual acuity postoperatively (75% > or =20/400) was significantly better than the preoperative visual acuity (25% > or =20/400, p= 0.0001). Endothelial decompensation due to congenital glaucoma is a very rare indication for PKP. The incidence of graft failure is high, and nonimmunologic reasons are the leading causes of graft failure in this high-risk population. Visual acuity can be significantly improved but is usually still very limited by advanced glaucomatous optic nerve damage and amblyopia. Efficient control of IOP before and after PKP is mandatory in eyes with buphthalmos to avoid graft failure and progress of glaucomatous optic nerve atrophy.

Penetrating keratoplasty for silicone oil keratopathy.

Penetrating keratoplasty for silicone oil keratopathy is associated with high risks and limited visual prognosis. This study examined the outcomes and factors influencing graft failure. A retrospective, non-comparative, interventional case series of patients attending Moorfields Eye Hospital, London. A total of 24 penetrating keratoplasties were performed in 17 patients (13 men and four women) from 1991 to 2000. The mean age of patients undergoing surgery was 43.6 years (range 17-84 years, SD +/- 21.0). Silicone oil was removed before or during the time of initial penetrating keratoplasty in nine patients (52.9%) and left in situ in eight patients (47.1%). Ten out of 24 grafts survived (41.7%). The median duration of graft survival was 21 months (range 2 weeks-98 months) with median duration of follow up 33 months (range 2-100 months). At final follow up, the number of patients with a clear graft who had oil removed before or during the time of penetrating keratoplasty was seven out of 10 (70.0%). Risk factors for graft failure included hypotony, multiple keratoplasty, corneal neovascularization, rejection episode, silicone oil left in situ and postoperative glaucoma. Management of these complex patients requires a combined approach from anterior segment and vitreoretinal subspecialties. The long-term success of the graft can be improved if silicone oil is removed prior or during the time of penetrating keratoplasty.

Detection of herpes simplex virus type 1, 2 and varicella zoster virus DNA in recipient corneal buttons

AIMTo study the value of polymerase chain reaction (PCR) analysis, to detect viral DNA in recipient corneal buttons taken at the time of penetrating keratoplasty (PKP) in patients with an...

Natural history of cystoid macular edema in pseudophakic bullous keratopathy

A retrospective review of 25 consecutive patients having penetrating keratoplasty (PKP) with the preoperative diagnoses of pseudophakic bullous keratopathy (PBK) and cystoid macular edema (CME) was undertaken to analyze the natural history of preoperative CME following keratoplasty. Follow-up ranged from 13 to 54 months with a mean of 27 months. All patients had intraocular lens exchanges with 24 receiving posterior chamber lenses; 23 had lenses sutured to the posterior iris. Sixteen patients (64%) recovered a visual acuity of 20/40 or better. The average time for visual recovery to 20/40 was nine months with a range of two to 45 months. Eighteen (72%) had resolution of angiographic CME. Three patients previously diagnosed as having chronic CME recovered visual acuity of 20/40 or better. Cases of PBK with CME may have an excellent visual prognosis if the IOL is managed properly at the time of PKP.