Underwent Penetrating Keratoplasty Research Articles

CD23 mediated the induction of pro-inflammatory cytokines Interleukin-1 beta and tumor necrosis factors-alpha in Aspergillus fumigatus keratitis.

CD23 mediated the induction of pro-inflammatory cytokines Interleukin-1 beta and tumor necrosis factors-alpha in Aspergillus fumigatus keratitis.

Congenital central corneal dermoid: A rare entity.

To understand the pathogenesis of a central corneal dermoid (CD) in a 12-day-old child, a comparison of CD specimen was done with limbal dermoid (LD) and cadaveric corneal (CC) specimens by immuno-histochemical staining. The child underwent penetrating keratoplasty for visual rehabilitation. The corneal tissue was sent for histo-pathological and immunochemistry evaluation. The corneal specimen obtained was compared the origin of central CD with LD and CC based on their antigenic expression profile. Clinically over a period of 75 months post operatively the child maintained a clear graft. Hematoxylin and Eosin staining of LD had a typical morphology including stratified keratinized epithelium, hair shaft with pilo sebaceous glands, eccrine sweat glands, lymphocytes, and blood vessels. Immuno-histochemical staining showed positive stain for Cytokeratin 3 epithelial marker in the epithelium of CC, LD, and CD. Smooth muscle maker (SMA) was identified in LD and CD but not in the CC as it is devoid of blood vessels. Limbal stem cell maker (P63) was detected only in LD. Vimentin, a mesenchymal stem cell marker stained positively in all three tissues of CC, LD, and CD. Corneal dermoid showed positive staining for mesodermal tissue components compared to both ectodermal and mesodermal components in limbal dermoid suggesting possibly a different origin of corneal dermoid.

The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty.

The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors. Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records. Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05). In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.

Triple procedure in blood-stained cornea of a hemophilia patient

A 16-year-old male Type A hemophiliac patient has been reported with complaints of defective vision in the right eye (OD), following ocular trauma 9 months back for which he took treatment outside. On examination, he had blood staining of cornea and cataract in his right eye. His vision was perception of light + and projection of rays intact. After hematologist opinion, under peribulbar anesthesia, he underwent penetrating keratoplasty with pupillary membranectomy and cataractous lens removal with posterior chamber intraocular lens implantation under the cover of Factor VIII (antihemophilic factor). On day 21, the best-corrected visual acuity in OD was 6/6P. This case report emphasizes the fact that hemophiliac patients can be operated safely with appropriate hematological support.

Multiple layers on the Descemet membrane

To relate a case not described previously in the national multilateral ophthalmological literature of Descemet’s membrane. A 59-year-old pseudophakic woman diagnosed with bullous keratopathy underwent penetrating keratoplasty with an unusual finding of multiple layers of Descemet’s membrane, which were variable in shape and thickness. In addition, ovoid bodies with negative Gocott-Gomori (GMS) color were present. Discussion and Conclusion: As Descemet’s membrane has a fetal and a postnatal period in its development, it is frequently and well identifiable in histological [...]

Corneal dystrophies: A decade of experience in a reference center in Bogotá, Colombia

Purpose: To describe sociodemographic findings, frequency, and clinical characteristics of patients with corneal dystrophy who consulted an ophthalmologic national reference center in Bogotá-Colombia in 10 years.Methods: Observational, descriptive case series study was carried out. The information was obtained from reviewing medical records of patients who consulted the cornea service at an ophthalmologic national reference center in Bogotá-Colombia between 2008 and 2018. The diagnosis of corneal dystrophy was done according to the International Committee for Corneal Dystrophies classification, as well as the currently accepted specific name of the dystrophy. The type of dystrophy, clinical, diagnostic findings, sociodemographic characteristics, and type of treatment were evaluated.Results: A total of 151 eyes of 79 patients were analyzed; 68.3% of subjects were female. The mean age was 57.6 ± 18.9 years, with a range between 2 and 95 years. The median best-corrected visual acuity (BCVA) in all the groups at diagnosis was 0.30 LogMAR (interquartile range 0.5) or 20/40 Snellen. Lattice dystrophy type 1 and its variants had the worse BCVA. Fuchs' dystrophy (FD) was the most frequently identified. Regarding treatment, 80.1% (n = 121) did not require any, and 11.9% (n = 18) had a corneal transplant. Thirteen underwent penetrating keratoplasty. Of those, two had a clinical diagnosis of TGFB1 dystrophy, three of stromal dystrophy, and eight of endothelial dystrophy. DSAEK was performed in 5 eyes four had endothelial dystrophy and one had unclassified dystrophy.Conclusions: Adults and females were the most affected groups. FD was the most frequent and unclassified dystrophies were the second most frequently diagnosed. This highlights the importance of complementary studies such as optical coherence tomography of the anterior segment and genetic markers which are not currently universally available in our healthcare system.Ethical considerations: This study was approved by the Institutional Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.

Corneal cross-linking versus conventional management for keratoconus: a lifetime economic model

Aims To assess the cost-effectiveness of corneal collagen cross-linking (CXL) versus no CXL for keratoconus in the United States (US). Methods A discrete-event microsimulation was developed to assess the cost-effectiveness of corneal cross-linking (CXL, Photrexa + KXL combination product) versus no CXL for patients with keratoconus. The lifetime model was conducted from a US payor perspective. The source for CXL efficacy and safety data was a 12-month randomized, open-label, sham-controlled, multi-center, pivotal trial comparing CXL versus no CXL. Other inputs were sourced from the literature. The primary outcome was the incremental cost per quality-adjusted life year gained. Costs (2019 USD) and effects were discounted 3% annually. The impacts of underlying uncertainty were evaluated by scenario, univariate, and probabilistic analyses. Results Starting at a mean baseline age of 31 years and considering a mixed population consisting of 80% slow-progressors and 20% fast-progressors, the CXL group was 25.9% less likely to undergo penetrating keratoplasty (PK) and spent 27.9 fewer years in advanced disease stages. CXL was dominant with lower total direct medical costs (-$8,677; $30,994 versus $39,671) and more QALYs (1.88; 21.80 versus 19.93) compared to no CXL. Considering the impact of reduced productivity loss in an exploratory scenario, CXL was associated with a lifetime cost-savings of $43,759 per patient. CXL was cost-effective within 2 years and cost-saving within 4.5 years. Limitations Limitations include those that are common to similar pharmacoeconomic models that rely on disparate sources for inputs and extrapolation on short-term outcomes to a long-term analytical horizon. Conclusions Keratoconus is a progressive and life-altering disease with substantial clinical, economic, and humanistic consequences. The economic value of cross-linking is maximized when applied earlier in the disease process and/or younger age, and extends to improved work productivity, out-of-pocket costs, and quality of life.

Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis.

Objectives:To evaluate the prognostic factors affecting graft survival in patients undergoing penetrating keratoplasty (PKP) for infectious keratitis.Materials and Methods:Patients who underwent PKP for keratitis in our hospital between 2013 and 2018 were retrospectively reviewed. Patients who underwent therapeutic PKP at the inflammatory stage and were followed for at least 12 months were included in the study. Age, gender, follow-up period, time between diagnosis and surgery, lens status, presence of limbal involvement, presence of corneal ulceration, perforation, or corneal abscess, type of microorganism detected in culture, number of fortified medications used before surgery and duration of use, preoperative and postoperative visual acuity, postoperative graft transparency, postoperative complications, recurrence of infection, rate of re-keratoplasty, and indication for and timing of re-keratoplasty were recorded. The relationship between these findings and anatomic, therapeutic, and functional success were evaluated.Results:Fifty-nine patients were included in the study; 40 (67.8%) were male and 19 (32.2%) were female, and the mean age was 59.78±19.46 (6-91) years. Anatomic success was achieved in 58 patients (98.3%). Therapeutic success was achieved in 47 patients (79.7%) and there was a significant relationship between therapeutic success and re-keratoplasty and early re-keratoplasty (p<0.001 for both). Thirty-two patients (54.2%) had functional success and there was a significant relationship between the absence of postoperative complications and functional success (p=0.014).Conclusion:PKP is an effective treatment option in treatment-resistant keratitis or keratitis with impending perforation. The absence of postoperative complications and performing early re-keratoplasty in patients with recurrence increase the success rate.

Evaluation of the quality of life related to vision after penetrating keratoplasty

Abstract Introduction Organ and tissue donation and transplantation represent the most important therapeutic advance of current times. The cornea is, by far, one of the most transplanted tissues worldwide due to the immune privilege of this tissue, as well as the advances in microsurgery, existence of cornea banks, preservation of corneas, and use of anti-rejection therapy. However, many patients with successful corneal transplants (with clear corneas) experience poor vision in the post-operative period due to irregular astigmatism, or other complications. Objective To evaluate the quality of life related to vision in patients undergoing penetrating keratoplasty. Material and methods a cross-analytical study including patients with a history of penetrating keratoplasty, over 18 years of age, and at least 6 months after surgery. The patients answered the visual function questionnaire VFQ-25 (Visual Function Questionnaire), a tool validated for use in Spanish, in which, the higher the score, the better the quality of life. Results Thirty patients, 20 men and 10 women, with a mean age of 61.2 ± 18.7 years, were included. The time of evolution after the transplant was 17.7 ± 4 months. The total quality of life score was 74.9 ± 21.9, with significance in visual acuity (p Conclusion The results suggest that visual acuity, as well as the presence of systemic comorbidities, has a significant impact on quality of life.

Determination of Oxidative Stress Markers in the Aqueous Humor and Corneal Tissues of Patients With Congenital Hereditary Endothelial Dystrophy.

The aim of this study is to determine the presence of oxidative stress markers in the aqueous humor (AH) and corneal tissues of patients with congenital hereditary endothelial dystrophy (CHED). Interventional prospective study was undertaken to quantify levels of ascorbic acid and glutathione in the AH of patients with CHED. AH was collected from patients undergoing keratoplasty and levels of ascorbic acid and glutathione were determined using biochemical assays and measured spectrophotometrically. AH collected from pediatric patients with cataract were used as control. Corneal sections of patients who underwent penetrating keratoplasty were obtained, and presence of glutathione peroxidase 1, catalase, and superoxide dismutase was determined by immunohistochemistry. Tissue sections obtained from cadaveric corneas unsuitable for clinical transplant were used as control. Significantly increased ascorbic acid levels were determined in patients with CHED (605.6 ± 158.9 μM) compared with those in controls (190.5 ± 74.72 μM). However, a trend toward reduced level of glutathione was detected in patients with CHED compared with that in the controls. Increased glutathione peroxidase 1 staining and reduced expression of catalase was detected in corneal tissues of patients with CHED compared with those in control corneal tissues. There was no apparent changes observed in the expression of superoxide dismutase in the corneal sections obtained from patients with CHED. To the best of our knowledge, this is the first study to determine the levels of ascorbic acid and glutathione in AH of patients with CHED. Our data suggest the presence of oxidative stress in CHED that might be responsible for the pathological changes in patients with CHED.

Deep anterior lamellar keratoplasty with cross-linked acellular porcine corneal stroma to manage fungal keratitis.

To evaluate the effects of deep anterior lamellar keratoplasty (DALK) with cross-linked acellular porcine corneal stroma (APCS) and post-operative topical tacrolimus treatment in patients with fungal keratitis. This multicenter prospective study involved 25 cases of fungal keratitis that were treated by DALK with cross-linked APCSs and post-operative topical tacrolimus from December 2013 to November 2014 at the Wenzhou Eye Hospital and the Henan provincial Eye Hospital. Signs of post-operative inflammation, corneal reepithelialization, corneal neovascularization, and graft rejection were assessed, and best corrected visual acuity (BCVA), intraocular pressure (IOP), and APCS graft transparency were monitored for the 12-month follow-up period. All 25 patients underwent DALK without Descemet's membrane perforation. Corneal epithelium recovered completely in 17 patients in the first week, and APCS grafts maintained transparency in 18 patients at 1-year follow-up. The mean BCVA significantly improved from 2.16±0.32 (LogMAR) at baseline to 1.56±0.70 at 1-week (P<.001), 0.95±0.57 at 1-month (P<.001), and 0.70±0.51 at 3-month follow-ups (P<.001). The BCVA kept stable at 6-month and 12-month follow-ups. Post-operative topical tacrolimus alleviated the ciliary injection, except in one case which acute stromal rejection occurred. One patient developed fungal reinfection and underwent penetrating keratoplasty. Graft rejection occurred in three patients. No case was noted with graft splitting, elevated IOP or tacrolimus intolerance. DALK using cross-linked APCS combining topical tacrolimus treatment is safe and effective in managing fungal keratitis. It may ameliorate the shortage of corneal donation globally.

Penetrating Keratoplasty - Indications in a tertiary care center in Nepal.

Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Introduction: Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Conclusion: Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision. Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision.

Histopathological examination of congenital corneal staphyloma and prognosis after penetrating keratoplasty.

The aim of this study was to investigate the histopathological manifestations of congenital corneal staphyloma accompanied by anterior segment dysgenesis and evaluate the prognosis after penetrating keratoplasty with an ultralarge button graft.We retrospectively studied 8 pediatric patients with large congenital corneal staphylomas in the Department of Ophthalmology of Peking University Third Hospital, China, between September 2014 and December 2018. All patients underwent penetrating keratoplasty with ultralarge button grafts, as well as additional operations according to the abnormality of each eye. Pathological investigations of all samples obtained during penetrating keratoplasty were performed with hematoxylin and eosin staining.The main clinical characteristic of congenital corneal staphyloma was an extremely opaque and ectatic cornea. Histopathological examination showed abnormal corneal epithelia and stroma and an absence of Bowman membrane, Descemet membrane, and the endothelium. Different severities of anterior segment dysgenesis, presenting as various histopathological manifestations, were observed in all cases. Several postoperative complications occurred after penetrating keratoplasty in some of the patients; however, the complications were discovered and treated accordingly in a timely manner. Six patients achieved good visual outcomes and a satisfactory cosmetic appearance after penetrating keratoplasty. One patient eventually lost the transparency of the button because of corneal neovascularization, and 1 patient lost visual function because of retinal detachment.Congenital corneal staphyloma combined with anterior segment dysgenesis can exhibit various manifestations on histopathological examination. Penetrating keratoplasty with an ultralarge button graft seems to be a suitable treatment for congenital corneal staphyloma to obtain good functional and aesthetic prognoses.

Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty.

PurposeTo evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty.MethodsThis study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination.ResultsThe charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes).ConclusionTopical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.

Ocular surgery after herpes simplex and herpes zoster keratitis.

The recurrence of herpetic stromal keratitis (HSK) and herpes zoster ophthalmicus (HZO) has been reported after a variety of ocular surgeries. The aim of this study was to review the evidence on the preventive methods employed in the perioperative period in patients having undergone HSK/HZO. The PubMed and Web of Science databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning the prophylaxis against and risk of HSK/HZO recurrence in patients undergoing ocular surgery up to December 31, 2019. The disturbance of the corneal nerve plexus occurs during several ocular surgeries including penetrating keratoplasty, lamellar keratoplasty, corneal cross-linking, cataract surgery, as well as photorefractive and phototherapeutic procedures. Such trauma, as well as modulation of the ocular immunological response caused by steroids applied postoperatively, might engender the HSK/HZO reactivationwhich is not uncommon. There is strong evidence that oral prophylaxis should be recommended just after surgery in patients undergoing penetrating keratoplasty and having suffered from HSK/HZO. For other types of surgeries, the evidence is less compelling; nevertheless, a period of disease quiescence and oral prophylaxis should still be considered. Within the article, we discuss the available evidence for HSK/HZO prophylaxis in ocular surgery. Additional studies would be required to define the real risk of HSK/HZO recurrence following eye surgeries, and particularly cataract surgery, and to confirm the utility of perioperative HSK/HZO prophylaxis.

VISUAL REHABILITATION AFTER PENETRATING KERATOPLASTY

Introduction: Astigmatism is the most common cause of suboptimal vision after corneal transplantation despite a clear corneal graft.1 Based on several studies, 15–31% of patients undergoing penetrating keratoplasty (PK) may develop postoperative astigmatism greater than 5 diopters (D).2,3 Commonly practiced techniques for visual rehabilitation after PK consist of postoperative suture manipulation, optical correction consisting of spectacles and contact lenses, relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, toric phakic intraocular lenses, and finally regrafting.4 The aim of this study was to report our management strategies and their results performed for visual rehabilitation and management of astigmatism after PK. Patients and Methods: The records of 104 eyes of 98 patients (54male/44 female) who underwent PK between January 2013 and January 2015 in Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. The age, the indication for PK, interventions performed for visual rehabilitation, the duration of follow-up, the topographic and refractive astigmatism at the end of follow-up and the final BCVA were recorded. Results: The mean age of the patients was 54±23 years. The indications for PK included keratoconus, Fuch’s endothelial dystrophy, pseudophakic bullous keratopathy and corneal scarring (Figure 1).Fig. 1. The mean duration of follow up was 23±11.5 months. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 D of corneal astigmatism. Spectacle correction was performed in 86 eyes (83%) and contact lenses including rigid gas permeable and scleral lenses were fitted in 18 eyes (17%) who were unsatisfied with spectacle correction mostly due to higher order aberrations or high anisometropia (Figure 2).Fig. 2. Relaxing corneal incisions were performed in 23 eyes (22%) and toric intraocular lens implantation was performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of follow up was 3.4±2.6 D and 3.6± 1.9 D, respectively. Discussion: Intraoperative and postoperative suture manipulation have been described for minimising early postoperative astigmatism.5,6 After PK, sutures should be kept for at least one year. During this period, astigmatism >4 D can be reduced by suture manipulation consisting of selective interrupted suture removal and tension adjustment of running sutures.4 If significant astigmatism remains after suture removal, which cannot be corrected by optical means such as spectacle correction or contact lenses, surgical procedures can be performed.4 Conclusion: Although general guidelines are useful, it is important to individualize the management based on corneal topography and patient expectations for successful visual rehabilitation.

Clinical indications of penetrating keratoplasty in a tertiary care centre of North India

Background: Corneal diseases are one of the major causes of blindness and visual impairment in developing countries. Penetrating keratoplasty is a surgical procedure where a damaged or diseased cornea is replaced by donor corneal tissue. Aim was to determine the indications of penetrating keratoplasty (PK) in a tertiary health care centre of North India.Methods: A retrospective analysis of the records of 288 patients, who underwent penetrating keratoplasty (PK) from January 2016 to December 2018 at Regional Institute of Ophthalmology, PGIMS Rohtak were included in this study. All patients who underwent PK during this time period were included in our study except those who underwent regrafting.Results: A total of 288 patients who underwent penetrating keratoplasty (PK) surgery were included in our study. Out of 288, 184 (63.88%) were males and 104 (36.11%) were females. In our study, 162 (56.25%) patients underwent optical PK, 76 (26.38%) had tectonic PK and 50 (17.36%) underwent therapeutic PK. Most common indication for optical PK was bullous keratopathy followed by corneal opacity. Most common reason for tectonic PK was found to be corneal perforation while for therapeutic PK was sloughing corneal ulcer followed by recalcitrant fungal keratitis.Conclusions: Though bullous keratopathy (BK) was the most common indication for penetrating keratoplasty in North India, but in our study 27% patients had tectonic PK and 17% patients underwent therapeutic PK which is significantly higher than documented data from South India and developed countries. It can be because of low literacy level, lack of awareness and late presentation to ophthalmologist in North India.

Evaluación de la calidad de vida relacionada con la visión posterior a queratoplastia penetrante

IntroductionOrgan and tissue donation and transplantation represent the most important therapeutic advance of current times. The cornea is, by far, one of the most transplanted tissues worldwide due to the immune privilege of this tissue, as well as the advances in microsurgery, existence of cornea banks, preservation of corneas, and use of anti-rejection therapy. However, many patients with successful corneal transplants (with clear corneas) experience poor vision in the post-operative period due to irregular astigmatism, or other complications. ObjectiveTo evaluate the quality of life related to vision in patients undergoing penetrating keratoplasty. Material and methodsA cross-analytical study including patients with a history of penetrating keratoplasty, over 18years of age, and at least 6months after surgery. The patients answered the Visual Function Questionnaire25 (VFQ-25) of visual function, a tool validated for use in Spanish, in which the higher the score, the better the quality of life. ResultsThirty patients (20men and 10women), with a mean age of 61.2±18.7years, were included. The time of evolution after the transplant was 17.7±4months. The total quality of life score was 74.9±21.9, with significance in visual acuity (P<.001), and the presence of systemic comorbidities (P=.018). There was no significance between the transplant reason (P=.098) or ocular comorbidities (P=.119). ConclusionThe results suggest that visual acuity, as well as the presence of systemic comorbidities, has a significant impact on quality of life.

Incidence, Risk Factors and Treatment Outcomes of Intraocular Hypertension and/or Glaucoma Post-Penetrating Keratoplasty: A 5-Year Lebanese Retrospective Descriptive Study.

PurposeGlaucoma is one of the most common complications post-penetrating keratoplasty (PK). In this study, we report the Incidence, risk factors and treatment outcomes of intraocular hypertension (IOH) or/and glaucoma post-penetrating keratoplasty (PKG).MethodsA 5-year descriptive retrospective study, Lebanese patients who underwent PK at Beirut Eye & ENT Specialist Hospital, between 2012 and 2017, were included. Patients with history of glaucoma were excluded. IOH/PKG cases that necessitate treatment were identified and analyzed for the incidence, risk factors and treatment outcomes.ResultsA total of 189 eyes of 159 patients were included, with male/female ratio 1.6 and the mean age 47.2±21.3 years. Bullous keratopathy (BK) presented with a high mean age: 70.3 years while ectasia patients were the youngest: 36.5 years. 34.9% of eyes developed high IOP within a mean of 25 months of follow-up distributed between sub-groups of patient with corneal ectasia (22.5%), redo-PK (51.2%), bullous keratopathy (BK) (50%), keratitis (24.9%), and others (dystrophy, trauma …) (21.4%). High IOP developed in 67.4% of the diabetic patients. Visual acuity was less likely to improve in cases developing elevated IOP while postoperative complications were significantly high. In those refractory to medical treatment, trabeculectomy as a glaucoma surgery was effective in lowering the IOP. Combining procedures with PK was not a risk factor for glaucoma. Interrupted sutures and higher number of suturing were associated with increased IOP levels.ConclusionIOH developed in one out of three patients who underwent penetrating keratoplasty. DM, bullous keratopathy, infectious keratitis and redo-PK were highly associated with PKG, whereas high IOP was less likely to develop in cases with keratoconus. Glaucoma is considered a poor prognostic factor in patients post-PK.

Long-Term Maintenance of Corneal Endothelial Cell Density After Corneal Transplantation.

To investigate the key factors associated with eyes with an endothelial cell density (ECD) of ≥2000 cells/mm at 5 years after corneal transplantation. This retrospective cohort study included 174 eyes that underwent penetrating keratoplasty by 1 corneal specialist surgeon at the Baptist Eye Institute, Kyoto, Japan, from 1998 through 2011 and that were carefully followed for over 5 years postoperative. In all operated eyes, corneal ECD was measured at 1, 2, 3, 4, and 5 years postoperative. Multivariate analysis with adjustment for preoperative donor ECD was performed between eyes with an ECD of ≥2000 cells/mm and those with an ECD of <2000 cells/mm at 5 years postoperative. Of the 174 eligible eyes, 16 eyes (9.2%) had an ECD of ≥2000 cells/mm at 5 years postoperative, and the annual rate of endothelial cell loss (mean ± SD) was 2.3% ± 3.7%. Multivariate analysis findings revealed that the donor-associated and surgery-related factors were not significant factors. Only the recipient diagnosis of bullous keratopathy was significantly associated with an ECD of <2000 cells/mm at 5 years postoperative. Of those 16 eyes, 6 (37.5%) had a recipient diagnosis of bullous keratopathy. None of the donor- and surgery-related factors, previously recognized as associated with a lower endothelial cell loss after penetrating keratoplasty, were found to be significant in this study, thus suggesting that there are still unknown factors associated with maintaining a higher ECD over the long-term postoperative period.