Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on d...Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.展开更多
AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial...AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.展开更多
AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patie...AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.展开更多
Dear Editor,I am Dr.Jo?o Beato,from the Ophthalmology Department of Sao Jo?o Hospital Center,Porto,Portugal.I write to present a case of combined penetrating keratoplasty(PKP)with temporary Eckardt keratoprosthesis,pa...Dear Editor,I am Dr.Jo?o Beato,from the Ophthalmology Department of Sao Jo?o Hospital Center,Porto,Portugal.I write to present a case of combined penetrating keratoplasty(PKP)with temporary Eckardt keratoprosthesis,pars plana vitrectomy(PPV)and Ahmed glaucoma valve(AGV)implantation into the ciliary sulcus in a patient with previous history of展开更多
Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard ...Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard method has not yet been defined. Aim: To present the role of large penetrating keratoplasty (PK) in the management of keratoglobus. Case Presentation: A 29-year-old male patient with bilateral keratoglobus presented with acute corneal hydrops in his right eye following extensive Descemet’s membrane rupture, with a visual acuity in this eye limited to hand movement. Peripheral cornea was extremely thin and blue sclera was present. Acute hydrops was managed conservatively at this stage and two months later large PK was performed in the right eye using 9.5 mm diameter graft over a 9 mm patient’s cornea trephination. Minor aqueous leakage was seen on the first postoperative day, managed with 2 more interrupted 10.0 nylon sutures. No further complications were noticed and postoperative course was uneventful. Fifteen months postoperatively the graft was clear and best corrected visual acuity was 20/60. Conclusions: Large penetrating keratoplasty has an important role in the management of keratoglobus, in cases where peripheral tuck-in lamellar keratoplasty or epikeratoplasty present serious intraoperative difficulties in host lamellar dissection and in stabilizing the graft due to extensive peripheral corneal and scleral thinning.展开更多
AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the ...AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P =0.961), corneal graft clear rate (P =0.132) or the incidence of recurred fungal infection (P =0.770) between two groups. But there was a higher incidence of graft rejection (P =0.020) and secondary glaucoma (P =0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.展开更多
AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May...AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.展开更多
Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in...Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.展开更多
AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the dat...AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up<8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.展开更多
· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patien...· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patients treated with PK and DALK, respectively, between March 2006 and April 2010. Corneal ECD was examined using specular microscopy at postoperative 1, 3, 6, 12, and 18 months, and the values were compared. · RESULTS: Corneal ECD reduction in the PK group was 7.4%, 15.2%, 23.5%, and 28.9% at 3, 6, 12 and 18 months respectively after surgery, compared with 4.2 % in the first month (P <0.01). These figures were 3.0%, 6.7%, 7.2%, and 7.7% at 3, 6, 12 and 18 months respectively, compared with 2.2 % in the first month in the DALK group (P >0.05). · CONCLUSION: Compared with DALK,PK significantly reduced ECD of the clear grafts. These results suggest that survival of endothelial cells in grafts is better after DALK than after PK. ·展开更多
Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneou...Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty(PKP) which was performed three years ago. An Ahmed glaucoma valve(New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure(IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1%(Sina Darou, Tehran, Iran)with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema.Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.展开更多
AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a ret...AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. ·RESULTS: The mean age of patients was 61 years. The mean overall follow -up was 27 months. The most common indications for surgery were corneal scarring (45.5% ), previous failed graft (15.8% ), corneal ulcer (12.9% ), Fuchs endothelial dystrophy (8.9% ), stromal dystrophy (2.9% ), and other conditions (14.5% ). Overall, 69 grafts (68.3% ) remained clear at final follow -up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P >0.05). The graft rejection rate (17.8% ) was a significant risk factor for failure (P =0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P >0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P <0.01). ·CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.展开更多
AIM: To analyse the impact of ultrasound and optical intraocular lens(IOL) calculation methods on refractive outcomes of cataract phacoemulsification performed after penetrating keratoplasty(PK) in keratoconus. METHOD...AIM: To analyse the impact of ultrasound and optical intraocular lens(IOL) calculation methods on refractive outcomes of cataract phacoemulsification performed after penetrating keratoplasty(PK) in keratoconus. METHODS: Phacoemulsification cataract surgery was performed on 42 eyes of 34 patients with keratoconus who had previously undergone PK. The IOL power was determined by using both standard and corneal topography-derived keratometry using the SRK/T formula. We used two independent methods-ultrasound biometry(UB) and interferometry [optical biometry(OB)] for IOL calculation. The analysed data from medical records included demographics, medical history, best corrected visual acuity(BCVA) on Snellen charts, technique of IOL calculation and calculation formula and its impact on final refractive result.RESULTS: BCVA ranged from 0.01 to 0.4(mean 0.09±0.19) before surgery and ranged from 0.2 to 0.7(mean 0.38±0.14) at 1 mo and from 0.2 to 1.0(mean 0.56±0.16)(P<0.05) at 3 mo, postoperatively. The refractive aim differed significantly from the refractive outcome in both the UB and OB groups(P<0.05). There was no statistically significant difference in the accuracy of the two biometry methods.CONCLUSION: The refractive aim in keratoconus eyes post-PK is not achieved with either ultrasound or OB.展开更多
AIM:To analyze the changing trends in penetrating keratoplasty(PKP)indications.METHODS:This retrospective study included all patients with PKP between 2006 and 2017.Patients were classified using histological diagnose...AIM:To analyze the changing trends in penetrating keratoplasty(PKP)indications.METHODS:This retrospective study included all patients with PKP between 2006 and 2017.Patients were classified using histological diagnoses.Our groups were as the following:pseudophakic or aphakic bullous keratopathy,regraft,acute necrotizing and ulcerative keratitis,keratoconus,Fuchs'dystrophy,corneal dystrophy other than Fuchs',corneal scar,other diagnoses and failed endothelial keratoplasty graft.Additionally,two different time-periods(2006-2012 and 2013-2017)were analysed.RESULTS:Totally 1721 histological analyses of 1214 patients were available for review.The diagnoses were pseudophakic or aphakic bullous keratopathy in 487(28.3%),regraft in 443(25.7%),acute necrotizing and ulcerative keratitis in 313(18.2%),corneal scar in 153(8.9%),keratoconus in 140(8.1%).Fuchs'dystrophy in 61(3.5%),corneal dystrophy other than Fuchs'in 46(2.7%),other diagnoses in 44(2.6%)and failed endothelial keratoplasty graft in 34(2.0%)cases.From the first to the second analysed time-period,incidence of acute necrotizing and ulcerative keratitis,corneal scar,Fuchs'dystrophy increased(P<0.032 for all)and incidence of keratoconus significantly decreased(P=0.015).CONCLUSION:Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP,followed by regraft and acute necrotizing and ulcerative keratitis.展开更多
Dear Editor,We write to introduce a novel technique of penetrating keratoplasty(PK)with lower risk of graft rejection in high-risk grafts.Corneal transplantation may be required in a variety of conditions such as kera...Dear Editor,We write to introduce a novel technique of penetrating keratoplasty(PK)with lower risk of graft rejection in high-risk grafts.Corneal transplantation may be required in a variety of conditions such as keratoconus,pseudophakic bullous keratopathy(PBK),and corneal scars or dystrophies[1].展开更多
AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHOD...AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.展开更多
AIM:To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty(PKP).METHODS:In this retrospective study of consecutive patients who had phacoemul...AIM:To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty(PKP).METHODS:In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin0.5% ophthalmic solution(0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity(BCVA), corneal endothelial cell count(ECC), and central corneal thickness(CCT).RESULTS:Fifty-five patients were recruited(26 males,29 females). The mean age was 54.36±4.97y(range 45-64y).All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively,which was statistically significant(P <0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33 ±1.01 s. The mean ECC was 2340.20 cells/mm2 preoperatively and 1948.75 cells/mm21 mo postoperatively(P <0.001). The increase of21.09 μm in postoperative pachymetry 1mo after surgery was statistically significant(P <0.001).CONCLUSION:Nountowardeffectswereobservedafter intracameral injection of moxifloxacin(0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.展开更多
AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into gener...AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into general anesthesia group(group A,70 eyes)and local anesthesia group(group B,71 eyes).Patients received optical PKP(group A1,30 eyes;group B1,30eyes)or therapeutic PKP(group A2,40 eyes;group B2,41 eyes).Measurement of anterior chamber treatment time(T)for PKP patients and the ratio(R)of the area of the pupils to that of recipient graft region.T and R values,as well as perioperative and postoperative complications,were compared between groups A and B using t-test orχ2test.RESULTS:Patients were followed for 2wk after PKP.T was(13.45±8.64)min for group A and(7.36±5.24)min for group B,a statistically significant difference(P<0.001).The R value for group A was stable during the operation,while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing.In group B,extrusion of intraocular contents occurred in 5 eyes,and iridal prolapse occured in 11cases;no perioperative complications occurred in group A.Relapse rate for fungal keratitis was 13.04%in group B and 0%in group A.CONCLUSION:Under general anesthesia,pupils remaine stable during PKP and perioperative complications are averted.General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.展开更多
AIM:To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty.METHODS:We searched the Cochrane Central Register of Co...AIM:To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty.METHODS:We searched the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,EMBASE,CNKI,VIP and reference lists of articles.Date of most recent search:18 June,2011.All randomised controlled trials(RCTs) assessing the use of immunosupressants in the prevention of graft rejection,irrespective of publication language.Two authors assessed trial quality and extracted data independently.Only dichotomous outcomes(clear graft survival,ratio of immune reactions and side effects) were available and were expressed as relative risk(RR) and 95% confidence intervals(CI).RESULTS:Seven studies were included in this review.In the comparing of mycophenolate mofetil(MMF) with placebo,the results showed MMF could significantly reduce immune reactions compared with placebo(RR 1.08 95% Cl 0.95 to 1.21),but no effect on clear graft survival(RR 1.11 95% Cl 0.90 to 1.35).In clear graft survival and immune reactions,MMF and cyclosporine A(CsA) showed similar effect(RR 1.11 95% Cl 0.90 to 1.35,and RR 1.48,95% Cl 0.56 to 3.93,respectively).Tacrolimus(FK506) and steroid showed similar effects on clear graft survival and immune reactions(RR 0.32,95% CI 0.02 to 6.21,and RR 1.00,95%CI 0.88 to 1.14,respectively).No drug relative side effect has been found.CONCLUSION:MMF may reduce immune reactions in both normal-risk and high-risk rejection of penetrating keratoplasty.CsA and FK506 showed similar effects as MMF.However,due to the lack of large clinical trials,the evidence remain weak,the quality of evidences were rated as very low to moderate.Large,properly randomised,placebo-controlled,double masked trials are needed to evaluate the effect of immunosuppressants.展开更多
AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Total...AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.展开更多
基金Supported by The Ophthalmic Research Center,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘Deep anterior lamellar keratoplasty(DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty(PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
文摘AIM:To compare visual,surgical and topographic outcomes of deep anterior lamellar keratoplasty(DALK)and penetrating keratoplasty(PK)for keratoconus(KC).METHODS:In this multicenter,prospective,randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK.RESULTS:Mean best spectacle corrected visual acuity(BSCVA)at the first postoperative week(P=0.012)and the first postoperative month(P<0.001)was statistically significantly higher in DALK group. The mean BSCVA at12 mo was not significantly different for DALK(0.30±1.99 log MAR)versus PK(0.40±0.33 log MAR)(P=0.104). The76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4%in PK group(P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group(P=0.644). Mean spherical equivalent was-2.94 D in DALK and-3.09 D in PK group.Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31(81.6%)of DALK and 29(76.3%)of PK(P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie,seen in 39.5% in DALK and 23.7% in PK. CONCLUSION:Big bubble DALK provides an earlier visual improvement compare to PK. However,visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However,intraoperativeperforation of the Descemet's membrane is a significant complication.
基金Supported by the National Natural Science Foundation of China (No.81500703)the Natural Science Foundation of Shandong Province (No.ZR2015YL027)the Innovation Project of Shandong Academy of Medica Sciences
文摘AIM: To review the indications of penetrating keratoplasty(PK) and anterior lamellar keratoplasty(ALK) at Qingdao Eye Hospital, Shandong Eye Institute, Qingdao, China, from 2010 to 2017. METHODS: The data of all patients undergoing PK or ALK from January 2010 to December 2017 was retrospectively reviewed, with the indications during 2010-2013 and 2014-2017 compared. RESULTS: A total of 1869 eyes were included, among which 1405 eyes(75.2%) had PK and 464 eyes(24.8%) had ALK. The leading indications were suppurative keratitis(36.8%), keratoconus(15.5%), herpes keratitis(13.1%), and regraft(10.5%). In eyes undergoing PK, the top four indications were suppurative keratitis(38.7%), herpes keratitis(15.3%), keratoconus(12.6%), and regraft(12.5%) during 2014-2017, with the proportion of suppurative keratitis and herpes keratitis decreased while regraft and keratoconus increased compared with 2010-2013. In eyes with ALK, suppurative keratitis(30.8%), keratoconus(24.1%), corneal dystrophies and degenerations(10.6%), and corneal dermoid tumor(9.7%) were the top four indications, and there was no significant difference for the proportion of each indication between 2010-2013 and 2014-2017. CONCLUSION: Suppurative keratitis is the most common indication for PK and ALK at Qingdao Eye Hospital during 2010-2017, followed by keratoconus, herpes keratitis, and regraft. In eyes treated with PK, the proportion of suppurative keratitis and herpes keratitis decrease while regraft and keratoconus increase during 2014-2017 compared with 2010-2013.
文摘Dear Editor,I am Dr.Jo?o Beato,from the Ophthalmology Department of Sao Jo?o Hospital Center,Porto,Portugal.I write to present a case of combined penetrating keratoplasty(PKP)with temporary Eckardt keratoprosthesis,pars plana vitrectomy(PPV)and Ahmed glaucoma valve(AGV)implantation into the ciliary sulcus in a patient with previous history of
文摘Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard method has not yet been defined. Aim: To present the role of large penetrating keratoplasty (PK) in the management of keratoglobus. Case Presentation: A 29-year-old male patient with bilateral keratoglobus presented with acute corneal hydrops in his right eye following extensive Descemet’s membrane rupture, with a visual acuity in this eye limited to hand movement. Peripheral cornea was extremely thin and blue sclera was present. Acute hydrops was managed conservatively at this stage and two months later large PK was performed in the right eye using 9.5 mm diameter graft over a 9 mm patient’s cornea trephination. Minor aqueous leakage was seen on the first postoperative day, managed with 2 more interrupted 10.0 nylon sutures. No further complications were noticed and postoperative course was uneventful. Fifteen months postoperatively the graft was clear and best corrected visual acuity was 20/60. Conclusions: Large penetrating keratoplasty has an important role in the management of keratoglobus, in cases where peripheral tuck-in lamellar keratoplasty or epikeratoplasty present serious intraoperative difficulties in host lamellar dissection and in stabilizing the graft due to extensive peripheral corneal and scleral thinning.
基金National Natural Science Foundation of China (No.81170825)
文摘AIM: To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty(PKP) for fungal keratitis. METHODS: A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. RESULTS: Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P =0.961), corneal graft clear rate (P =0.132) or the incidence of recurred fungal infection (P =0.770) between two groups. But there was a higher incidence of graft rejection (P =0.020) and secondary glaucoma (P =0.039) in group with corneal graft diameter 8.00mm or larger. CONCLUSION: PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis.Effective, preventive and therapeutic measures can improve the prognosis.
基金Supported by National Natural Science Foundation of China(No.30630063)
文摘AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.
文摘Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.
文摘AIM:To investigate the long-term results of penetrating keratoplasty(PK)in patients with keratoconus(KC)and to evaluate factors that might influence the final visual outcome.METHODS:We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980to December 2005.The age of the patients,preoperative best-corrected visual acuity(BCVA),corneal thickness,death to preservation time,and preservation to transplantation time were recorded.Additionally,postoperative complications such as graft rejection,development of glaucoma and specular microscopy were checked during the follow-up.RESULTS:Sixty-nineeyesfrom69patientswerefinally included.The follow-up period was 8.64±6.13y.Graft rejection occurred in 4 eyes of 69 cases(5.8%),and the time to graft rejection was 2.1±1.3y.A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6,13,and 17y after PK were 95.6%,90.0%,and 78.8%,respectively.When we evaluated factors that might influence final BCVA in eyes,no disparity donor-host trephine size(same graft size)as well as higher spherical equivalent,and average Kvalue were associated with higher final BCVA.(P=0.006,0.051,0.092,and 0.021 in eyes with follow-up<8y;P=0.068,0.065,and 0.030 in eyes with follow-up≥8y,respectively).CONCLUSION:The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA.Less myopic change and low average K-reading,as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.
文摘· AIM: To compare the corneal endothelial cell density (ECD) of clear grafts after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). · METHODS: The study included 44 and 54 patients treated with PK and DALK, respectively, between March 2006 and April 2010. Corneal ECD was examined using specular microscopy at postoperative 1, 3, 6, 12, and 18 months, and the values were compared. · RESULTS: Corneal ECD reduction in the PK group was 7.4%, 15.2%, 23.5%, and 28.9% at 3, 6, 12 and 18 months respectively after surgery, compared with 4.2 % in the first month (P <0.01). These figures were 3.0%, 6.7%, 7.2%, and 7.7% at 3, 6, 12 and 18 months respectively, compared with 2.2 % in the first month in the DALK group (P >0.05). · CONCLUSION: Compared with DALK,PK significantly reduced ECD of the clear grafts. These results suggest that survival of endothelial cells in grafts is better after DALK than after PK. ·
文摘Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty(PKP) which was performed three years ago. An Ahmed glaucoma valve(New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure(IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1%(Sina Darou, Tehran, Iran)with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema.Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.
文摘AIM: To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP). ·METHODS: We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months. ·RESULTS: The mean age of patients was 61 years. The mean overall follow -up was 27 months. The most common indications for surgery were corneal scarring (45.5% ), previous failed graft (15.8% ), corneal ulcer (12.9% ), Fuchs endothelial dystrophy (8.9% ), stromal dystrophy (2.9% ), and other conditions (14.5% ). Overall, 69 grafts (68.3% ) remained clear at final follow -up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P >0.05). The graft rejection rate (17.8% ) was a significant risk factor for failure (P =0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P >0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P <0.01). ·CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.
文摘AIM: To analyse the impact of ultrasound and optical intraocular lens(IOL) calculation methods on refractive outcomes of cataract phacoemulsification performed after penetrating keratoplasty(PK) in keratoconus. METHODS: Phacoemulsification cataract surgery was performed on 42 eyes of 34 patients with keratoconus who had previously undergone PK. The IOL power was determined by using both standard and corneal topography-derived keratometry using the SRK/T formula. We used two independent methods-ultrasound biometry(UB) and interferometry [optical biometry(OB)] for IOL calculation. The analysed data from medical records included demographics, medical history, best corrected visual acuity(BCVA) on Snellen charts, technique of IOL calculation and calculation formula and its impact on final refractive result.RESULTS: BCVA ranged from 0.01 to 0.4(mean 0.09±0.19) before surgery and ranged from 0.2 to 0.7(mean 0.38±0.14) at 1 mo and from 0.2 to 1.0(mean 0.56±0.16)(P<0.05) at 3 mo, postoperatively. The refractive aim differed significantly from the refractive outcome in both the UB and OB groups(P<0.05). There was no statistically significant difference in the accuracy of the two biometry methods.CONCLUSION: The refractive aim in keratoconus eyes post-PK is not achieved with either ultrasound or OB.
文摘AIM:To analyze the changing trends in penetrating keratoplasty(PKP)indications.METHODS:This retrospective study included all patients with PKP between 2006 and 2017.Patients were classified using histological diagnoses.Our groups were as the following:pseudophakic or aphakic bullous keratopathy,regraft,acute necrotizing and ulcerative keratitis,keratoconus,Fuchs'dystrophy,corneal dystrophy other than Fuchs',corneal scar,other diagnoses and failed endothelial keratoplasty graft.Additionally,two different time-periods(2006-2012 and 2013-2017)were analysed.RESULTS:Totally 1721 histological analyses of 1214 patients were available for review.The diagnoses were pseudophakic or aphakic bullous keratopathy in 487(28.3%),regraft in 443(25.7%),acute necrotizing and ulcerative keratitis in 313(18.2%),corneal scar in 153(8.9%),keratoconus in 140(8.1%).Fuchs'dystrophy in 61(3.5%),corneal dystrophy other than Fuchs'in 46(2.7%),other diagnoses in 44(2.6%)and failed endothelial keratoplasty graft in 34(2.0%)cases.From the first to the second analysed time-period,incidence of acute necrotizing and ulcerative keratitis,corneal scar,Fuchs'dystrophy increased(P<0.032 for all)and incidence of keratoconus significantly decreased(P=0.015).CONCLUSION:Pseudophakic or aphakic bullous keratopathy is the leading indication for PKP,followed by regraft and acute necrotizing and ulcerative keratitis.
文摘Dear Editor,We write to introduce a novel technique of penetrating keratoplasty(PK)with lower risk of graft rejection in high-risk grafts.Corneal transplantation may be required in a variety of conditions such as keratoconus,pseudophakic bullous keratopathy(PBK),and corneal scars or dystrophies[1].
文摘AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.
文摘AIM:To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty(PKP).METHODS:In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin0.5% ophthalmic solution(0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity(BCVA), corneal endothelial cell count(ECC), and central corneal thickness(CCT).RESULTS:Fifty-five patients were recruited(26 males,29 females). The mean age was 54.36±4.97y(range 45-64y).All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively,which was statistically significant(P <0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33 ±1.01 s. The mean ECC was 2340.20 cells/mm2 preoperatively and 1948.75 cells/mm21 mo postoperatively(P <0.001). The increase of21.09 μm in postoperative pachymetry 1mo after surgery was statistically significant(P <0.001).CONCLUSION:Nountowardeffectswereobservedafter intracameral injection of moxifloxacin(0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.
文摘AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into general anesthesia group(group A,70 eyes)and local anesthesia group(group B,71 eyes).Patients received optical PKP(group A1,30 eyes;group B1,30eyes)or therapeutic PKP(group A2,40 eyes;group B2,41 eyes).Measurement of anterior chamber treatment time(T)for PKP patients and the ratio(R)of the area of the pupils to that of recipient graft region.T and R values,as well as perioperative and postoperative complications,were compared between groups A and B using t-test orχ2test.RESULTS:Patients were followed for 2wk after PKP.T was(13.45±8.64)min for group A and(7.36±5.24)min for group B,a statistically significant difference(P<0.001).The R value for group A was stable during the operation,while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing.In group B,extrusion of intraocular contents occurred in 5 eyes,and iridal prolapse occured in 11cases;no perioperative complications occurred in group A.Relapse rate for fungal keratitis was 13.04%in group B and 0%in group A.CONCLUSION:Under general anesthesia,pupils remaine stable during PKP and perioperative complications are averted.General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.
文摘AIM:To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty.METHODS:We searched the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,EMBASE,CNKI,VIP and reference lists of articles.Date of most recent search:18 June,2011.All randomised controlled trials(RCTs) assessing the use of immunosupressants in the prevention of graft rejection,irrespective of publication language.Two authors assessed trial quality and extracted data independently.Only dichotomous outcomes(clear graft survival,ratio of immune reactions and side effects) were available and were expressed as relative risk(RR) and 95% confidence intervals(CI).RESULTS:Seven studies were included in this review.In the comparing of mycophenolate mofetil(MMF) with placebo,the results showed MMF could significantly reduce immune reactions compared with placebo(RR 1.08 95% Cl 0.95 to 1.21),but no effect on clear graft survival(RR 1.11 95% Cl 0.90 to 1.35).In clear graft survival and immune reactions,MMF and cyclosporine A(CsA) showed similar effect(RR 1.11 95% Cl 0.90 to 1.35,and RR 1.48,95% Cl 0.56 to 3.93,respectively).Tacrolimus(FK506) and steroid showed similar effects on clear graft survival and immune reactions(RR 0.32,95% CI 0.02 to 6.21,and RR 1.00,95%CI 0.88 to 1.14,respectively).No drug relative side effect has been found.CONCLUSION:MMF may reduce immune reactions in both normal-risk and high-risk rejection of penetrating keratoplasty.CsA and FK506 showed similar effects as MMF.However,due to the lack of large clinical trials,the evidence remain weak,the quality of evidences were rated as very low to moderate.Large,properly randomised,placebo-controlled,double masked trials are needed to evaluate the effect of immunosuppressants.
文摘AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.
