Treatment Of Bullous Keratopathy Research Articles

Descemet membrane endothelial keratoplasty after implantation of glaucoma drainage devices

To study the possibility of performing modified Descemet membrane endothelial keratoplasty (DMEK) with maximum graft diameter, and to assess its short-term effectiveness in the treatment of bullous keratopathy (BK) in the presence of a glaucoma drainage device in the anterior chamber. Modified surgery 3/4-DMEK was performed in 9 eyes of 7 patients with BK and Ahmed glaucoma drainage using graft of maximum diameter (11±1 mm). Average follow-up time was 15.3±2.5 months (12 to 18 months). No intraoperative or postoperative complications were observed. Mean ECD after 12 months amounted to 1664±346 cells/mm2, which corresponds to ECD reduction of 34±9.6% (24 to 49%) in comparison to preoperative values. Mean best corrected visual acuity 12 months after surgery increased from 0.04±0.03 (0.01 to 0.1) to 0.3±0.2 (0.04 to 0.7). The last follow-up examination revealed all corneas to have preserved transparency and stable pachymetry measurements (from 488 to 548 µm). Performing 3/4-DMEK with a mega graft for treatment of BK after drainage surgery is technically possible. Absence of Descemet membrane (DM) donor and preservation of DM recipient in the drainage tube plane eliminates its contact with the endothelium. Maximum graft diameter should in the long term help prolong the effectiveness of the surgery.

Systematic review of clinical research on regenerative medicine for the cornea.

To conduct a systematic review of clinical research on the use of regenerative medicine for the cornea in human patients. A systematic literature search of MEDLINE and the Cochrane Library was performed in May 2020. Forty-two articles were identified. Thirty-eight of those articles focused on the treatment for limbal stem cell deficiency (LSCD), of which 17 articles involved autologous cultured limbal epithelial cell sheet transplantation (CLET), 13 involved allogeneic CLET, and 14 involved autologous cultured oral mucosal epithelial cell sheet transplantation (COMET). For autologous CLET, the median ocular surface reconstruction rate, visual recovery rate, incidence of immunologic rejection, infectious keratitis, and ocular hypertension/glaucoma were 74.1%, 54.5%, 0%, 4.6%, and 6.3%, respectively. For allogeneic CLET, they were 71.4%, 71.4%, 7.1%, 12.0%, and 7.1%, respectively. For autologous COMET, they were 66.7%, 66.7%, 0%, 5.3%, and 8.1%, respectively. Systemic immunosuppressants and steroid medications were predominantly used following allogeneic CLET, whereas they were not routinely used after autologous CLET. Three studies focused on the treatment of keratoconus using autologous adipose-derived adult stem cells and reported no marked adverse events. One study reported on the treatment of bullous keratopathy using allogeneic cultured corneal endothelial cells. All patients achieved an endothelial cell density of >500 cells, and the corrected distance visual acuity improved in 82% of the treated eyes. The results show that regenerative medicine for the cornea demonstrated a satisfactory efficacy and safety. Through translational research, we are expecting to establish a new treatment for waiting patients.

A pilot study of genipin cross-linking effects on bullous keratopathy in rabbits

AIM: To evaluate the effects of genipin cross-linking on bullous keratopathy in rabbits. METHODS: Nine female New Zealand white rabbits with bullous keratopathy were used as an experimental model. They were randomized into three groups. Corneas in Group A (treatment group, n=3) were immersed in 0.25% genipin at 24℃ for 40min; those in Group B (control group, n=3) were immersed in 0.9% sodium chloride solution at 24℃ for 40min; and those in Group C (blank control group, n=3) received no treatment. Follow-up examinations were performed within 2wk after treatment, including slit-lamp microscopy, central corneal thickness (CCT), evaluations of body weight and stress responses, histopathological analyses, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) for detecting stromal cell apoptosis. RESULTS: Compared to Groups B and C, remission of corneal edema, corneal healing, disappearance of epithelial bullae, a significant decrease in CCT (P<0.05), and a significant increase in body weight (P<0.05) were found in Group A. Animals in Group A became more active and showed less aggression and violent resistance behavior. More regular and dense arrangement of collagen fibers in the corneal stroma and formation of blue strips of cross-linking products were observed in Group A. Cell apoptosis occasionally occurred in the corneal stroma of Group A, while no cell apoptosis was observed in Groups B and C. CONCLUSION: Genipin cross-linking treatment for bullous keratopathy in rabbits results in remission of corneal edema and relief of pain. We hypothesize that genipin cross-linking strengthens collagen fibers in corneal stroma to avoid the formation of corneal edema and bullae.

Clinical outcome after Descemet membrane endothelial keratoplasty in vitrectomized eyes

Purpose The aim of the present study was to evaluate the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous vitrectomy. Patients and methods This is a retrospective review of medical records and surgical videos of all DMEK cases in vitrectomized eyes (total or anterior vitrectomy) that were done at Alexandria Main University Hospital, Alexandria, Egypt, between January 2015 and November 2019. The primary outcome measure was the improvement in best-corrected visual acuity. Secondary outcome measures were unfolding time and technique, endothelial cell loss, and rebubbling rate. Results A total of 18 vitrectomized eyes of 18 patients with bullous keratopathy were included in this study. Follow-up duration ranged from 6 to 53 months, with a mean of 23.8±15.2 months. At the end of the follow-up, the best-corrected visual acuity improved from 1.9±0.5 log MAR units to 0.7±0.4 log MAR units. The mean endothelial cell density was 1136.6±204.4 cells/mm2, representing 53% loss of the mean preoperative donor endothelial cells (2388.3±114.8 cells/mm2). The mean graft unfolding time was 13.7±5.4 min. A total of 11 (61%) eyes needed rebubbling owing to postoperative Descemet membrane detachment. Conclusion DMEK is an effective surgical modality for treatment of bullous keratopathy in vitrectomized eyes. Restoration of corneal clarity and significant visual improvement were possible in all patients, despite the need for complex surgical steps, prolonged surgical time, and the increased rebubbling rate.

NS Endo-Inserter: A New Graft Inserter for Descemet Stripping Automated Endothelial Keratoplasty.

Although Descemet stripping automated endothelial keratoplasty (DSAEK) has become widespread as a first choice for the treatment of bullous keratopathy, corneal endothelial cell loss during the early postoperative period caused by intraoperative mechanical stress to the donor endothelium remains a clinical challenge. At present, a pull-through technique is the standard procedure for graft delivery in DSAEK. However, the anterior chamber is likely to collapse during graft delivery in patients with a small eye or shallow anterior chamber, as often seen in Asian patients, leading to endothelial cell damage. To solve this problem, we developed a new device for DSAEK, known as NS Endo-Inserter, in which the graft flows into the anterior chamber in a balanced salt solution in one step. This article reviews the features of NS Endo-Inserter and the outcomes of DSAEK using this device.

Современные подходы к хирургическому лечению буллезной кератопатии

Современные подходы к хирургическому лечению буллезной кератопатии

A novel technique of endothelium keratoplasty: injection of corneal endothelial cells into anterior chamber

Endothelium keratoplasty(EK), due to its short operation time, fast postoperative healing and better postoperative visual prognosis, has gradually replaced penetrating keratoplasty in recent years as the preferred surgery for treating corneal endothelial decompensation.A recent study has reported the clinical results of the successful treatment of bullous keratopathy with human corneal endothelial cells cultured in vitro and anterior chamber injection, which opened a new era of EK.This method simplifies the operation procedure, avoids the complications related to the dislocation of corneal endothelial graft, and significantly improves the utilization rate of donor corneal materials.Nevertheless, long-term prognosis and outcome of patients undergoing this treatment remain to be clarified before introducing this approach into wider clinical practice. Key words: Keratoplasty; Corneal endothelial cells; Prognosis

Surgical Treatment of Bullous Keratopathy: Modern Approaches and Trends

According to WHO, corneal pathology is the fourth cause (5.1 %) of blindness among the main causes of significant visual impairment in the world after cataract, glaucoma and macular degeneration. Bullous keratopathy is a serious progressive corneal disease, in which the endothelial lesion plays the main role leading to the chronic corneal edema, reduce of visual acuity, development of pain syndrome, formation of permanent opacities, and various infectious complication, which may result in eye globe loss. Since the second half of 90th XX century various modifications of modern posterior (endothelial) keratoplasty have been introduced in the clinical practice, which were subsequently used widely for the treatment of bullous keratopathy. The introduction of new microkeratomes used in refractive surgery significantly contributed to the development of endothelial keratoplasty microsurgical technique, which enables the high quality, selective replacement of the affected corneal layers in comparison to the manual lamellar keratoplasty techniques. One of the contraindications for endothelial keratoplasty is an irreversible central stromal opacity. In that case, modern technologies and new equipment (particularly femtosecond laser) provide an opportunity to perform the penetrating keratoplasty with a complex-shaped profile and corresponding edges of the graft and its bed. In bullous keratopathy, top-hat keratoplasty represents the pathogenically targeted treatment method that allows transplanting of more endothelial cells with a relatively smaller diameter of graft’s anterior segment. This article reviews the literature on modern surgical treatment of bullous keratopathy.

MODIFICATION OF TRACK-ETCHED MEMBRANES BY LOW-TEMPERATURE PLASMA

Published data appearing in the last decade on the modification of track-etched membranes with the use of low-temperature plasma are considered. Some schematic description of setups and methods for sample processing in discharges of various types in atmosphere of non-polymerizing gases and by plasma polymerization, also by using of such plasma-chemical methods as magnetron sputtering of polymer targets and electron-beam dispersion of polymers in vacuum are presented. Some modern physicochemical methods for studying of changes occurring on the surface of membranes are described. Some typical examples of changes in the contact properties of the track-etched membrane surface and their chemical composition by means of X-ray photoelectron spectroscopy and Fourier-IR spectroscopy are given. Using the methods of atomic force microscopy and electron microscopy, some examples of morphological changes occurring on the surface of track membranes and in the volume of pores are presented. It is shown that the modification of track membranes by low temperature plasma leads to the creation of “smart” membranes, which possess some unique properties. This allows to significantly expand the areas of their application. Modified membranes can be used as thermosensitive elements and mechanochemical membranes with a “chemical valve”.The plasma treatment allows also significantly change the biocompatibility of the surface of track-etched membranes and use them in medicine and biology. By means of some special techniques, studies of the adsorption and growth of cellular and biological structures on the surface of modified track-etched membranes are presented.The possibility of the modified track membranes using as a highly effective biocompatible drainage material in the surgical treatment of refractory glaucoma, as well as implants in the treatment of bullous keratopathy is shown.Forcitation:Kravets L.I.,Gilman A.B. Modification of track-etched membranes by low-temperature plasma. Izv. Vyssh. Uchebn. Zaved. Khim. Khim. Tekhnol. 2018. V. 61. N 4-5. P. 4-30

Analysis of clinical efficacy and safety of excimer laser technology in the treatment of bullous keratopathy

Analysis of clinical efficacy and safety of excimer laser technology in the treatment of bullous keratopathy

Corneal stroma amniotic membrane transplantation for the treatment of bullous keratopathy

Objective To evaluate the therapeutic effects of corneal stroma amniotic membrane transplantation for bullous kerafopthy. Methods Ten eyes of 10 patients with bullous keratopathy were included (6 males and 4 females). The average age was 65.0±3.30 years old (ranged from 45 to 78 years old). 7 eyes were after phacoemulsification and intraocular lens implantation. Other 3 eyes were after glaucoma and cataract surgery. Pedicle corneal flap was made by microkeratome. Amniotic membrane of 4 mm × 5 mm was implanted. Then the flap was sutured 3 stitches with 10-0 nylon sutureo. The postoperative effects of short and long term were observed and recorded. Results All the patients were followed up for 3 to 6 months. Corneal epithelium of all eyes were recovered within 10 days. 8 eyes with eye pain were completely healed. Limitated vesicles in peripheral cornea occurred in 2 eyes. The postoperative visual acuity were improved significantly in 4 patients. Conclusion Corneal stroma amniotic membrane transplantation can not only relieve pain, but also improve visual acuity. Thus, it is an important clinical temporary treatment for bullous keratopathy when donor corneal tissues were limited and restricted. Key words: Keratopathy, bullous; Stroma, corneal; Transplantation, amniotic membrane

Intérêt et applications du Cross-Linking du colagène cornéen en ophtalmologie vétérinaire

Corneal collagen cross-linking : interests and applications in veterinary ophthalmology. Corneal collagen cross-linking (CXL) is a photochemical process based on the production of free radicals by a chromophore (riboflavin) after activation by a UVA beam. Corneal effects are as follows : improvement of the corneal strength and of its resistance to enzymatic digestion, inactivation of in situ microbial germs and modulation of the corneal inflammatory response. Veterinary applications of this process are adapted from human ophthalmology and consist first in the treatment of confirmed or supposed corneal infections. PACK-CXL (Photo-Activated Chromophore for Keratitis – CXL) is a serious option for the treatment of corneal melts in dogs, cats and horses and can replace tectonic surgery. The second application is the treatment of bullous keratopathy in canine patients for which the CXL provides the symptomatic relief of the chronic corneal ulceration although corneal edema remains unchanged.

Kornea Çapraz Bağlama Tedavisinin Büllöz Keratopatili Hastalarda Yaşam Kalitesi Üzerine Etkisi

Objective: To evaluate the effect of corneal cross-linking (CXL) on quality of life in patients with bullous keratopathy. Material and Methods: The study was designed as prospective, comparative, single-center and nonrandomized cohort. Ten patients with painful bullous keratopathy to whom CXL was applied were included in the study group. Ten consecutive patients with painful bullous keratopathy who didn't accept CXL were admitted as the control group. Besides routine ophthalmic examinations, SF-36 (Short Form-36) questionnaire was also performed to all patients at baseline. All examinations were repeated at first, 3rd, 6th and 12th months. Results: A significant improvement in ''Physical Functioning'' and ''Vitality'' subscales starting from the first month after CXL, continuing up to the postoperative 6th month (p=0.04, p=0.01, respectively) was achieved. An improvement in ''Bodily Pain'' subscale was achieved starting at the 3rd month after CXL, and continued until the 6th month (p=0.01, p=0.01, respectively). Unfortunately, there was a deterioration in ''Physical Functioning'', ''Bodily Pain'', and ''Vitality'' subscales starting from the 6th month, with statistically significant variations between the 6th and the 12th months (p=0.02, p=0.02, p=0.02, respectively). In the control group, there was a significant deterioration in ''Physical Functioning'', ''Bodily Pain'', ''General Health'', and ''Social Functioning'' subscales between baseline and the 12th month (p=0.02, p=0.04, p=0.02, p=0.03, respectively). Conclusion: CXL may be useful in the treatment of bullous keratopathy when waiting for keratoplasty, particularly in patients with intense pain by temporarily improving the quality of life.

Treatment of bullous keratopathy with corneal collagen cross‐linking in two dogs

Corneal collagen cross-linking with riboflavin and UV-A (CXL) decreases corneal oedema and increases visual acuity in human patients with bullous keratopathy. Presumed mechanisms are an increase in collagen packing density and a reduction in stromal swelling pressure. We present two cases in which CXL was used to treat bullous keratopathy in dogs. Four eyes of two dogs with painful bullous keratopathy-induced corneal erosions that were resistant to prior therapy were treated with CXL. Both corneas of the second patient were dehydrated to ± 400 μm corneal thickness using topical 70% glycerol solution immediately prior to CXL. Follow-up included slit-lamp examination, fluorescein staining and photographic documentation in both cases and high-resolution ultrasound examination in the second patient. All four eyes were comfortable and fluorescein negative at 1-week post-CXL and remained so for the rest of the follow-up period (17.5 months for case 1 and 6 months for case 2). The owner of the first patient reported a less oedematous cornea and improvement in vision that lasted for 6 months. Despite a reported lack of improvement in vision in the second patient, corneal thickness initially decreased, but was back at baseline thickness at the 4-month recheck. Similar to humans, CXL might become a useful treatment option for bullous keratopathy-induced therapy-resistant corneal erosions in dogs. Patient comfort was greatly improved, but corneal thickness decrease was not as long-lasting as reported for humans. The presently used protocols might need modification to fit the dog cornea.

Prospective Comparison of Two Suturing Techniques of Amniotic Membrane Transplantation for Symptomatic Bullous Keratopathy

To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK). Randomized, double-blind controlled clinical trial. setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups. The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046). The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.

7 Cases of Combined Corneal Tattooing and Amniotic Membrane Transplantation in Bullous Keratopathy

Purpose: We report on the clinical efficacy of the combined operation of corneal tattooing and amniotic membrane transplantation on the treatment of bullous keratopathy in patients with poor visual potentials. Case summary: We performed corneal tattooing and amniotic membrane transplantation in 7 eyes with bullous keratopathy. Postoperatively, we assessed the status of corneal reepithelialization, postoperative pain, and cosmetic effects. In all cases but one, corneal reepithelialization was successful without pain, and the corneal tattooing persisted throughout the follow-up period. In one case, a corneal epithelial defect developed, so we performed an additional amniotic membrane transplantation. After 2 weeks, the corneal epithelial defect healed and caused no further pain. Conclusions: The combined operation of corneal tattooing and amniotic membrane transplantation is a good choice for the treatment of bullous keratopathy with regard to cosmetic problems, pain, and poor visual potential.

Bandage Lenses in the Treatment of Bullous Keratopathy

Bandage Lenses in the Treatment of Bullous Keratopathy

The use of Gundersen Flaps in the Treatment of Bullous Keratopathy

The use of Gundersen Flaps in the Treatment of Bullous Keratopathy