Underwent Penetrating Keratoplasty Research Articles

Outcomes of keratoplasty in a cohort of Pythium insidiosum keratitis cases at a tertiary eye care center in India.

To assess outcomes of keratoplasty performed in patients diagnosed with keratitis caused by Pythium insidiosum (PI). Retrospective review. Preoperative, intra operative and post operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were collected from the central patient database of a tertiary eye care hospital in India. The data were analyzed for anatomic success, elimination of infection, graft survival, incidence of repeat keratoplasty, final visual acuity and varied complications. In total, 16 eyes underwent penetrating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from onset of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, seven of which required a repeat keratoplasty for elimination of infection. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Three grafts remained clear at 6-month follow up while 11 grafts failed. Mean improvement in uncorrected visual acuity from 2.32 to 2.04 logMAR was observed at last follow up. Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after keratoplasty. PI keratitis is a tenacious and potentially blinding condition. Keratoplasty remains the choice of treatment in this condition, however recurrence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post operative use of antibiotics can help in improving outcome of keratoplasty in these patients.

Temporary Pupil Scaffolding Technique for Managing Positive Vitreous Pressure and Impending IOL and Vitreous Extrusion During Penetrating Keratoplasty.

Positive vitreous pressure (PVP)secondary to intraoperative acute hypotony during penetrating keratoplasty can result in extrusion of the intraocular lens and vitreous. Currently described techniques are difficult or impossible to apply intraoperatively when positive vitreous pressure is noticed in an"open sky"situation after excision of the host corneal button. We describe a technique where pupil scaffolding is used to prevent intraocular lens or crystalline lens extrusion by simply closing the pupil with a temporary suture that holds the retropupillary contents back. Once the eye is thus stabilized, the donor cornea is sutured rapidly after which the pupillary knot is cut and removed using microscissors and microforceps. Five patients undergoing penetrating keratoplasty under peribulbar anesthesia underwent this technique after experiencing PVP after host corneal button excision. PVP was successfully controlled in all 5 patients, and the optical grafts remained clear in the postoperative period. Temporary pupillary scaffolding can help control PVP and prevent ocular content extrusion during PKP surgeries.

Unveiling the landscape of post-keratoplasty keratitis: a comprehensive epidemiological analysis in a tertiary center.

The present study aimed to epidemiologically evaluate patients with infectious keratitis following corneal transplantation. This retrospective study analyzed medical records of patients who underwent keratoplasty from March 2014 to March 2022 at a tertiary center. A total of seventy-five patients were evaluated. The data were classified based on culture results, the type of microorganisms involved, treatment requirements, and the type of primary keratoplasty performed. Seventy-five patients were evaluated in this study, with a mean age of 45.9years (22-95years). The mean duration between the first surgery and the incidence of infectious keratitis was 1.43years, and most cases occurred in the first year (56.2%). Bacterial and fungal keratitis in 2.17%, 1.39%, and 1.26% of cases undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) occurred, respectively. Streptococcus viridans (9.3%) and Staphylococcus aureus (6.6%) had the highest prevalence. Across various smear and culture results (gram-positive, gram-negative, fungal, and negative culture), no significant differences were found in endophthalmitis rates (P = 0.797) and the necessity for tectonic grafts (P = 0.790). Similarly, the choice of surgical method (PK, ALK, EK) showed no significant impact on the need for tectonic grafts (P = 0.45) or the rate of endophthalmitis (P = 0.55). The incidence of keratitis after a corneal graft was 1.7%, with Streptococcus viridans and Staphylococcus aureus the most common microorganisms. The rate of endophthalmitis associated with post-keratoplasty keratitis was 0.053%. There was no correlation between the necessity for a tectonic graft or the incidence of endophthalmitis and the type of microorganisms involved.

Post-Penetrating Keratoplasty Assessment of Endothelial Function With a Scleral Lens Challenge.

Patients who have undergone penetrating keratoplasty may have corneal edema because of endothelial cell dysfunction. Scleral lens wear may exacerbate edema, particularly if lens fit is suboptimal. Distinguishing between edema because of inherent endothelial cell dysfunction and swelling because of scleral lens-related hypoxia can be challenging. It is necessary, however, to identify the most likely cause of increased corneal thickness to determine whether the patient simply needs refitting for a different lens design or needs additional surgical intervention. This case report describes the utility of corneal tomographic imaging before and after scleral lens wear both to estimate endothelial cell function and to direct decisions when designing a scleral lens for a post-transplant eye.

Evidence for persistent UV-induced DNA damage and altered DNA damage response in xeroderma pigmentosa patient corneas

Xeroderma pigmentosum (XP) is a rare genetic disorder characterized by injury to the ocular surface due to exposure to ultraviolet (UV) radiation. UV-induced damage in the cells leads to the formation of cyclobutane pyrimidine dimers (CPDs) and 6-4 pyrimidine-pyrimidone photoproducts that are repaired by the NER (Nucleotide Excision Repair) pathway. Mutations in the genes coding for NER proteins, as reported in XP patients, would lead to sub-optimal damage repair resulting in clinical signs varying from photo-keratitis to cancerous lesions on the ocular surface. Here, we aimed to provide evidence for the accumulation of DNA damage and activation of DNA repair pathway proteins in the corneal cells of patients with XP. Corneal buttons of patients who underwent penetrating keratoplasty were stained to quantify DNA damage and the presence of activated DNA damage response proteins (DDR) using specific antibodies. Positive staining for pH2A.X and thymidine dimers confirmed the presence of DNA damage in the corneal cells. Positive cells were found in both control corneas and XP samples however, unlike normal tissues, positive cells were found in all cell layers of XP samples indicating that these cells were sensitive to very low levels of UV. pH2A.X-positive cells were significantly more in XP corneas (p < 0.05) indicating the presence of double strand breaks in these tissues. A positive expression of phosphorylated-forms of DDR proteins was noted in XP corneas (unlike controls) such as ataxia telangiectasia mutated/Rad-3 related proteins (ATM/ATR), breast cancer-1 and checkpoint kinases-1 and -2. Nuclear localization of XPA was noted in XP samples which co-localized (calculated using Pearson's correlation) with pATM (0.9 ± 0.007) and pATR (0.6 ± 0.053). The increased presence of these in the nucleus confirms that unresolved DNA damage was accumulating in these cells thereby leading to prolonged activation of the damage response proteins. An increase in pp53 and TUNEL positive cells in the XP corneas indicated cell death likely driven by the p53 pathway. For comparison, cultured normal corneal epithelial cells were exposed to UV-radiation and stained for DDR proteins at 3, 6 and 24 h after irradiation to quantify the time taken by cells with intact DDR pathway to repair damage. These cells, when exposed to UV showed nuclear translocation of DDR proteins at 3 and 6 h which reduced significantly by 24 h confirming that the damaged DNA was being actively repaired leading to cell survival. The persistent presence of the DDR proteins in XP corneas indicates that damage is being actively recognized and DNA replication is stalled, thereby causing accumulation of damaged DNA leading to cell death, which would explain the cancer incidence and cell loss reported in these patients.

Corneal Transplant Rejection Postvaccination Among Medicare Beneficiaries.

The purpose of this study was to describe the incidence of corneal graft rejection after COVID and influenza vaccination. Patients 65 years or older undergoing penetrating keratoplasty or endothelial keratoplasty any time between 2016 and 2021 followed by COVID or influenza vaccination in 2021 among the 100% Medicare Fee-For-Service database were included. Demographic and ocular history characteristics of patients with (cases) and without graft rejection (controls) were compared using the χ2 test. After COVID (n = 31,398) and influenza (n = 24,290) vaccination, 0.45% (n = 140) and 0.17% (n = 41) patients developed rejection within 90 days, respectively. There was no difference in the rate of graft rejection within 90 days relative to 90 to 180 days after vaccination after both COVID (90 days: 0.45% vs. 180 days: 0.61%, P = 0.37) and influenza (90 days: 0.17% vs. 180 days: 0.29%, P = 0.11) vaccines. For COVID vaccination, patients who underwent penetrating keratoplasty (n = 51, 0.97%; vs. endothelial keratoplasty = 89; 0.34%, P < 0.001), history of rejection up to 1 year before vaccination (n = 13; 1.30% vs. no history = 127, 0.42%; P < 0.001), and having an ocular comorbidity (n = 110, 0.54% vs. no ocular comorbidity = 30, 0.27%; P = 0.001) had higher rates of graft rejections, and most rejections were after 1 year postkeratoplasty (87.14%, n = 122). The incidence of graft rejection postvaccination is low compared with the overall rates of rejection in the published literature. Most post-COVID vaccination graft rejections were after 1 year postkeratoplasty when corticosteroids are expected to have been tapered to lower doses. Surgeons may counsel patients regarding graft rejection symptoms, but overall low rates may not warrant pretreatment in low-risk keratoplasty patients.

Epstein-Barr virus-positive iris diffuse large B-cell lymphoma detected by metagenomic next-generation sequencing

PurposeEpstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a relatively rare subtype of DLBCL. Herein, we report a case of a patient with EBV-positive iris DLBCL after undergoing penetrating keratoplasty and discuss its possible pathogenesis.MethodsA 72-year-old male patient presented to our hospital with progressive blurring of vision in the left eye for the past 4 months. Small white nodular lesions were observed on the iris and retinal surface of the left eye, with a white cloud-like opacity in the vitreous cavity.ResultsThe patient was eventually diagnosed with EBV-positive iris DLBCL after undergoing pathological and metagenomic tests. After injecting methotrexate in the left vitreous cavity and administering systemic and local antiviral treatments, the ocular lesions disappeared.ConclusionEBV infection, drug immunosuppression, and aging-related immune deterioration may play significant roles in the pathogenesis of EBV-positive iris DLBCL.SynopsisEpstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a new subtype of DLBCL, which rarely occurs. Herein, we report a case of a patient with EBV-positive iris DLBCL after undergoing penetrating keratoplasty and discuss its possible pathogenesis.

PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection.

To compare prevalence of positive PCR tests for herpesviruses between patients with and without a history of clinical corneal endothelial allograft rejection (AGR). Retrospective cross-sectional study with two-group comparison. A total of 307 aqueous humor (AH) samples from 235 Patients and 244 eyes who underwent penetrating keratoplasty or Descemet membrane endothelial keratoplasty or had a diagnostic AH aspiration due to clinical AGR between 2019 and 2023 were tested for DNA of herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). PCR test results were compared between the two groups (with/without AGR). Another sub-analysis examined the results of patients without a history of herpetic keratitis. A total of 8% of eyes with clinical AGR (9/108) had a positive PCR result for one of the herpesviruses (HSV:3, CMV:3, EBV:2, VZV:1). All patients in the group without AGR had negative PCR results for all previous viruses (0/136). The difference was statistically significant (p < 0.001). The sub-analysis of eyes without a history of herpetic keratitis also revealed significantly more positive herpes PCR results (7/87) in eyes with AGR than in eyes without AGR (0/42, p = 0.005). Clinical AGR after keratoplasty shows a significant correlation to viral replication. Herpetic infection and AGR could occur simultaneously and act synergistically. Timely differentiation between active herpetic infection and/or AGR is pivotal for proper treatment and graft preservation.

Initial Outcome of Subconjunctival Bevacizumab for Corneal Neovascularization - a Case Series

Introduction : Corneal neovascularization (CNV) has a variety of causes and threatens corneal clarity, thus optimal visual acuity. Conventional medical management includes topical steroids and matrix metalloproteinase inhibitors like doxycycline. Anti-vascular endothelial growth factor (anti-VEGF) agents have demonstrated promise but remain off-label for this indication.&#x0D; Case Illustration : We present three patients with corneal neovascularization varied in etiology who underwent subconjunctival injection of Bevacizumab . Case 1: a-female-69 years old came with blurred vision after had Stephen Johnson Syndrome which affect her cornea. The examination revealed opacification of cornea accompanied by neovascularization at 5 until 9 o’clock position up to edge of pupil in the left. Case 2: a-male-47 years old presented corneal haze with neovascularization almostin all corneal region on background of fungal keratitis. Case 3: a-male-63 years old who underwent penetrating keratoplasty of indication corneal lekoma following an episode of fungal keratitis. There was opacity in all corneal region and neovascularization in 360 degree of limbus. All of these patients showed regression of neovessel after first injection of bevacizumab.&#x0D; Discussion : Corneal neovascularization is a condition caused by disruption homeostasis in which proangiogenic balanced by antiangiogenic, thereby maintaining avascularity. Bevacizumab as VEGF-A-binding proteins could prevent VEGF-A from binding cell surface receptors.&#x0D; Conclusion : Subconjunctival injection of Bevacizumab can be considered as a treatment for corneal neovascularization. It has shown promising effects in recess neovascularization in cornea regardlessthe etiology.

Efficacy of tacrolimus capsules in patients undergoing high-risk keratoplasty

Purpose: To evaluate the efficacy of tacrolimus capsules in patients undergoing high-risk keratoplasty.&#x0D; Methods: 40 high-risk patients who underwent penetrating keratoplasty at The Third Hospital of Hebei Medical University, China between January 2016 and December 2021 were included in this study. These patients were divided into two groups based on the specific immunosuppressant administered post-surgery. Twenty patients were administered oral tacrolimus capsules in conjunction with 0.1 % tacrolimus eye drops, constituting the combination with systemic treatment group (group 1), while another twenty patients were solely administered 0.1 % tacrolimus eye drops, forming the topical treatment group (group 2). The occurrence of rejection, corneal neovascularization, corneal graft edema and visual acuity were documented in both groups.&#x0D; Results: In comparison to patients in group 2, patients in group 1 exhibited a significant reduction in rejection rate (p &lt; 0.05). Additionally, the average time of neovascularization in group 1 was delayed and the number of cases was lower (p &lt; 0.05). Furthermore, a smaller proportion of patients in group 1 experienced corneal graft edema (25 vs 60 %, p &lt; 0.05), while a higher percentage of patients in group 1 demonstrated improved visual acuity (90 vs 60 %, p &lt; 0.05).&#x0D; Conclusion: Concurrent administration of tacrolimus eye drops and capsules orally effectively mitigates anti-rejection reactions, regulation of neovascularization, management of graft edema and enhancement of visual acuity in high-risk keratoplasty patients when compared to the use of tacrolimus eye drops as a standalone treatment. These results have the potential to stimulate novel avenues of investigation in future clinical research.

A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

Background. Performing penetrating keratoplasty in 100 % of cases leads to the occurrence of induced postkeratoplasty astigmatism, which can be more than 12,0 D. If cataracts occur in this category of patients, performing cataract phacoemulsification with implantation of a toric intraocular lens (tIOL) does not completely solve the problem. The use of the method of implantation of intrastromal corneal segments at stage I before cataract phacoemulsification makes it possible to reduce the degree of postkeratoplasty astigmatism and create optimal conditions for additional correction of residual postkeratoplasty astigmatism due to the implantation of tIOL during cataract phacoemulsification.The aim. To analyze the clinical and functional indicators of correction of regular high-grade postkeratoplasty astigmatism in a patient with cataracts using a combined method, including first implantation of intrastromal corneal segments and subsequent cataract phacoemulsification with implantation of toric intraocular lens using the example of a clinical case.Material and methods. A 55-year-old patient with cataracts, who had a history of undergoing penetrating keratoplasty, contacted us. According to the keratotopogram data, a regular postkeratoplasty astigmatism of 18.68 D was diagnosed. The patient underwent a combined method. At stage I, intrastromal corneal segments were implanted into the corneal graft, then after 6 months stage II was performed – cataract phacoemulsification with implantation of tIOL.Results. Six months after intrastromal corneal segments implantation, the patient’s keratometric data stabilized, and corneal astigmatism decreased to 8.98 D. Then the patient underwent cataract phacoemulsification with tIOL implantation. After 1 month, the spherical component of refraction was 0.5 D, the cylindrical component of refraction was –0.5 D, visual acuity increased to 1.0.Conclusions. A combined method for correcting regular high-grade postkeratoplasty astigmatism in a patient with cataracts showed high refractive results, stability and safety in the long-term postoperative period.

Deep anterior lamellar keratoplasty and penetrating keratoplasty in macular corneal dystrophy: comparison of visual and topographic outcomes and complications.

This study aims to assess and compare the postoperative visual and topographic outcomes, complications, and graft survival rates following deep anterior lamellar keratoplasty and penetrating keratoplasty in patients with macular corneal dystrophy. In this study we enrolled 59 patients (23 male; and 36 female) with macular corneal dystrophy comprising 81 eyes. Out of these, 64 eyes underwent penetrating keratoplasty, while 17 eyes underwent deep anterior lamellar keratoplasty. The two groups were analyzed and compared based on best-corrected visual acuity, corneal tomography parameters, pachymetry, complication rates, and graft survival rates. After 12 months, 70.6% of the patients who underwent deep anterior lamellar keratoplasty (DALK) and 75% of those who had penetrating keratoplasty (PK) achieved a best-corrected visual acuity of 20/40 or better (p=0.712). Following surgery, DALK group showed lower front Kmean (p=0.037), and Q values (p<0.01) compared to the PK group. Postoperative interface opacity was observed in seven eyes (41.2%) in the DALK group. Other topography values and other complications (graft rejection, graft failure, cataract, glaucoma, microbial keratitis, optic atrophy) did not show significant differences between the two groups. The need for regrafting was 9.4% and 11.8% in the PK and DALK groups, respectively (p=0.769). Graft survival rates were 87.5% and 88.2% for PK and DALK; respectively (p=0.88 by Log-rank test). Both PK and DALK are equally effective in treating macular corneal dystrophy, showing similar visual, topographic, and survival outcomes. Although interface opacity occurs more frequently after DALK the visual results were comparable in both groups. Therefore, DALK emerges as a viable surgical choice for patients with macular corneal dystrophy without Descemet membrane involvement is absent.

Silicon-dried corneal graft crosslinking as a means to increase the effectiveness of urgent keratoplasty

Purpose: to evaluate the effectiveness of silicon-dried cornea, previously subjected to corneal collagen UVA crosslinking, for urgent keratoplasty.Material and methods. 28 patients (16 males, 12 females), diagnosed with perforating corneal ulcer of various etiologies, underwent penetrating keratoplasty for eye-preserving purposes. 14 patients (the main group) underwent transplantation of a silicon-dried cornea, previously subjected to corneal collagen crosslinking according to the standard (Dresden) protocol while the remaining 14 patients (comparison group) underwent penetrating keratoplasty with not pre-treated silicon-dried cornea. In the postoperative period, we measured the time of primary complete epithelization of the graft and assessed the presence/absence of ulcers and erosions of the corneal graft 1, 3, 6 and 12 months after the discharge from the hospital. For this purpose, all patients underwent corneal biomicroscopy with corneal surface preliminary stained with a 1% sodium fluorescein solution.Results. Complete epithelization in both the main group and the comparison group was found to take place, on average, at the same time after surgery. However, over the entire observation period, the main group showed fewer relapses of ulcers and corneal graft erosions than the comparison group.Conclusion. The use of silicon-dried cornea, subjected to corneal collagen cross-linking, increases the effectiveness of perforated corneal ulcer treatment in emergency surgical care.

Clinicopathologic Analyses of Failed Endothelial Keratoplasty (the Clinical Cases)

Purpose: To evaluate the clinicopathologic features of failed endothelial keratoplasty. Methods. In this study 11 patients (11 eyes) with recurrence of bullous keratopathy (BK) were included. Group 1 consisted of 4 patients who underwent repeat Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), group 2 included 7 patients who underwent penetrating keratoplasty (PK) after failed Descemet Membrane Endothelial Keratoplasty (DMEK). Preoperative anterior segment optical coherence tomography (OCT), RTVue-100, Optovue, USA, was performed. Intraoperatively aqueous humour (AqH) samples were collected for multiplex cytokine analysis. During keratoplasty failed grafts/corneal buttons were obtained and then investigated histologically (hematoxylin/eosin staining, primary antibodies to pancytokeratin, vimentin, collagen III). Results. Recurrence of BK in all clinical cases manifests by the increase of inflammatory factors in AqH, corneal edema, neovascularization and remodeling to fibrosis. Glaucoma may induce DMEK/ DSAEK graft failure due to chronic local inflammation. In the clinical cases recurrence of BK was caused by peripheral and central graft detachment, rebubbling, graft upside-down orientation and donor corneal genetic disorders. Conclusions. Chronic local inflammation (including corneal morphological changes) in patients with BK recurrence is an indication for reoperation. The modification of keratoplasty — DMEK/DSAEK/PK — is determined according to slit-lamp and OCT images of the cornea. High-level risk of immune reaction (especially in cases of three and more times repeated keratolasty) is the reason for systemic corticosteroid and, sometimes, cytostatic therapy.

Early Endophthalmitis Rates and Risk Factors After Corneal Transplant Surgeries in Medicare Beneficiaries From 2016 to 2019.

The aims of this study were to determine rates of early postkeratoplasty endophthalmitis and identify sociodemographic and medical risk factors in the Medicare population. Using a retrospective cohort design, patients aged 65 years and older undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) from 2016 to 2019 among 100% Medicare Fee-or-Service database were included. Rates of early endophthalmitis within 42 days of keratoplasty were determined using the International Classification of Diseases, 10th Revision-Clinical Modification diagnostic codes. Patient and physician characteristics were compared using x2 tests, and a multivariable logistic regression model was used to evaluate factors associated with endophthalmitis. The overall early endophthalmitis rate after keratoplasty was 0.39% (n = 216/54,822) with a median time to diagnosis of 14 (interquartile range: 5-25) days. Rates by keratoplasty types were 1.31% for cataract surgery combined with PK, 1.13% for PK, and 0.22% for EK. On multivariable analysis, the odds of endophthalmitis were higher for PK [odds ratio (OR): 5.46, 95% confidence interval (CI), 3.98-7.49] and ALK (OR: 5.45, 95% CI, 2.59-11.49) relative to EK. Patients with a Charlson Comorbidity Index (CCI) ≥3 had higher odds of endophthalmitis (OR: 1.82; 95% CI, 1.28-2.58) relative to patients with a CCI of 0. Practices located in the Midwest (OR: 0.59, 95% CI, 0.36-0.96), West (OR 0.57; 95% CI, 0.35-0.93), and Northeast (OR: 0.59 95% CI, 0.35-0.99) had lower odds of reporting endophthalmitis when compared to the South. Patients undergoing PK and ALK and those with a CCI ≥3 had higher odds of endophthalmitis relative to EK and patients without comorbidities, respectively. Practices in the West, Midwest, and Northeast had lower odds of endophthalmitis relative to the South.

Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

Background. Many patients after penetrating keratoplasty (PK) experience induced postkeratoplastic astigmatism, which is often irregular and causes an increase in corneal aberrations that reduce visual acuity and quality. The aim of the study. To conduct a comparative analysis of the effect of rigid gas permeable scleral lenses and the MyoRing implantation method on clinical and functional parameters in patients with IPA. Material and methods. The clinical study included 60 patients (60 eyes). The age of patients with IPA was from 25 to 42 years. All patients underwent penetrating keratoplasty. All patients were divided into two groups depending on the method for irregular postkeratoplastic astigmatism correction. Group I included 30 patients (30 eyes) who were fitted with rigid gas permeable scleral lenses. Group II consisted of 30 patients (30 eyes) who underwent implantation of the MyoRing into a penetrating corneal graft. The observation period was 1 year. Results. After 12 months of observation, there was a greater increase in uncorrected visual acuity by an average of 3 lines, in corrected visual acuity – by 2 lines; a greater decrease in corneal aberrations in photo- (root mean square (RMS) of total aberrations (RMS total) by 0.30 ± 0.08 µm, RMS of higher order aberrations (RMS HOA) – by 1.01 ± 0.24 μm) and mesopic conditions (RMS total – by 0.33 ± 0.09 μm, RMS HOA – by 0.08 ± 0.03 μm) in patients wearing rigid gas permeable scleral lenses compared with patients after MyoRing implantation into a penetrating corneal graft. Conclusion. Patients of group I, wearing rigid gas permeable scleral lenses, showed a greater improvement in visual acuity and a decrease in corneal aberrations in photo- and mesopic conditions compared to the patients of group II (after MyoRing implantation) at a follow-up period of 12 months.

Impact of patient adherence on the efficacy of penetrating keratoplasty

Objective: to determine the relationship between adherence to treatment in patients undergoing penetrating keratoplasty (PKP) and corneal graft survival over a 12-month follow-up period. Material and methods. A retrospective analysis of 56 patients who underwent "high risk" PKP was performed. Patients were divided into 2 groups according to their compliance. The full compliance group included those with more than 90% of visits within the first year after the intervention; the poor compliance group included those with more than 10% of missed visits. Results. The high adherence group was characterised by a higher proportion of women (p=0.033), a mean 7 years younger age of the patients (p=0.021) and a predominance of higher education (p=0.014). One year after PKP, patients with complete compliance (74%) were more likely to have a favourable outcome than those with incomplete compliance (48%) (p=0.046). The calculation of the odds ratio (OR 3.52; Cl: 1.1362-10.88; p=0.045) indicated a statistically significant role of treatment adherence as a factor in keratoplasty efficacy. The high compliance group had a visual acuity gain of 2 lines at 12 months (p=0.003). Conclusion. Compliance after corneal transplantation has a significant impact on graft survival and clinical outcome. The development and implementation of a set of measures to increase adherence could significantly improve the safety and efficacy of this high-tech treatment for patients with disabling corneal pathology.

Penetrating Keratoplasty in Congenital Glaucoma.

Childhood glaucoma is one of the most common causes of corneal opacity in childhood and is associated with various pathological corneal changes, including corneal enlargement, corneal clouding, and edema. Congenital glaucoma (CG) may cause a decrease in vision outcomes due to corneal opacity or clouding, which is often associated with stimulus deprivation amblyopia. Therefore, to create a balance between preventing amblyopia and sustaining corneal clearance, patients with CG can be managed with early penetrating corneal transplantation surgery along with advanced glaucoma management. To investigate the graft survival rate and factors affecting graft survival in patients with congenital glaucoma who underwent penetrating keratoplasty (PKP). Cross-sectional. Patients with congenital glaucoma who underwent PKP were retrospectively evaluated. The associations between age, corneal diameter, presence of ocular comorbidities, concurrent ocular surgeries with corneal graft, and visual outcomes were assessed. Among the 30 eyes enrolled in the study, 6 (20%) had aniridia, 6 (20%) had Axenfeld-Rieger syndrome, and 18 (60%) were diagnosed with primary congenital glaucoma. Graft survival rates were 66.6% and 63.33% at 12 and 24 months, respectively. At the end of the follow-up, the overall graft survival rate was 60%. Statistical significance was observed between patient age at the time of surgery and graft failure (p = 0.02). Graft failure was associated with a younger patient age. Functional vision was achieved in 53.3% of patients. The management of congenital glaucoma and its corneal complications is a delicate issue that requires great effort. PKP in congenital glaucoma was moderately successful in the present study. To provide functional vision, PKP could be the treatment of choice.

Prevalence of Herpes Simplex and Varicella-Zoster Virus DNA in Corneal Grafts Is Higher than Expected.

(1) To determine the prevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), varicella-zoster virus (VZV), and cytomegalovirus (CMV) DNA in donor corneas; (2) To evaluate the clinical outcome of the grafts with viral DNA and to compare donors with and without viral DNA. We analyzed data from all donors and recipients who underwent penetrating keratoplasty (PK) or Descemet membrane endothelial keratoplasty (DMEK) between September 2022 and March 2023. Donor corneoscleral rims and excised recipients' corneal buttons were tested for the presence of HSV-1, HSV-2, VZV, and CMV DNA by polymerase chain reaction (PCR). The results were known 2-3 days after the surgery. We closely followed up on patients whose grafts tested positive for viral DNA. We compared the medical histories of donors with and without viral DNA. We included 85 corneas from 67 donors. Seven (8.2%) donor corneas tested positive for HSV-1 (n = 3) or VZV (n = 4) DNA. We did not detect any HSV-2 or CMV DNA. In the postoperative follow-up of patients with positive PCR, a graft failure was observed in one and infections in two eyes. Re-operation was necessary in three of these cases (42.9%). Patients without herpes DNA in the donor cornea needed reoperation in 7.7% of the cases. Cultural duration, the cause of the donor's death, and the death-to-explantation interval did not differ significantly between donors with and without viral DNA. Additionally, 3 of the 7 (42.9%) donors with positive PCR were in a septic status at the time of death, compared to 21 of the 78 (26.9%) donors with negative PCR (p = 0.52). The prevalence of herpes DNA in the donor corneas was 8.2% and thus higher than previously reported. We did not notice any evidence for a donor-to-host transmission, but a higher rate of postoperative complications in recipients of the grafts with viral DNA. The donors with and without herpetic DNA did not differ significantly regarding systemic diagnoses or cultural conditions, but sepsis was more frequent in the group with viral DNA.

Identification and Analysis of Primary Cilia in the Corneal Endothelial Cells of Patients with Bullous Keratopathy

Purpose To identify primary cilia in human corneal endothelial cells (CECs) obtained from patients with bullous keratopathy (BK). Methods This study involved CEC specimens obtained from 10 eyes of 10 consecutive patients (three males and seven females; mean age: 74.5 years, range: 68–90 years) with BK who underwent Descemet’s stripping automated endothelial keratoplasty at Baptist Eye Institute, Kyoto, Japan between August 2019 and September 2020. Three corneal buttons obtained from 3 patients who underwent penetrating keratoplasty for keratoconus were used as 'non-BK' controls. All specimens were evaluated with immunofluorescence staining using an antibody against acetylated α-tubulin. Results Ciliary expression was observed in six of the 10 CEC specimens; i.e. in two specimens obtained from BK patients after glaucoma surgery (trabeculectomy), in two specimens obtained from patients with Fuchs endothelial corneal dystrophy, and in two specimens obtained from a patient with BK after laser iridotomy for primary angle closure. There was acetylated α-tubulin staining but no hair-like structures in two specimens, and ciliary expression was unknown in two specimens due to the absence of cells. The length of the primary cilia varied between all specimens. In contrast, no primary cilia were observed in the corneal buttons obtained from the three keratoconus patients. Conclusion The findings in this study clearly demonstrate the expression of primary cilia in the CECs of patients afflicted with BK.